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The Government of the Philippine Islands 

Department of Public Instruction^ 

Philippine Health Service 



REPORT OF THE 

PHILIPPINE HEALTH 
SERVICE 



FOR THE FISCAL YEAR FROM JANUARY 1 
TO DECEMBER 31, 1918 



J. D. Long, m.d., 

DIRECTOR OF HEALTH 
PREPARED UNDER THE DIRECTION OF 

VICENTE DE JESUS, M.D., 

ACTING DIRECTOR OF HEALTH 



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DEPARTMENT OF PUBLIC INSTRUCTION 


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The Government op^ the Philippine Islands 

Department of Public Instruction 

Philippine Health Service 



REPORT OF THE 

PHILIPPINE HEALTH 
SERVICE 



FOR THE FISCAL YEAR FROM JANUARY 1 
TO DECEMBER 31, 1918 



J. D. Long, M.D., 

DIRECTOR OF HEALTH 
PREPARED UNDER THE DIRECTION OF 

VICENTE DE JESUS, M.D., 

ACTING DIRECTOR OF HEALTH 



MANILA 

BUREAU OF PRINTING 

1919 



ANNUAL REPORT OF THE PHILIPPINE HEALTH 
SERVICE, FISCAL YF^AR 1918. 



Department of Public Instruction, 

Philippine Health Service, 

Manila, October 1, 1919. 

Sir : I have the honor to transmit herewith the annual report 
of the Philippine Health Service for the fiscal year ending 
December 31, 1918. 

THE YEAR IN BRIEF. 

While all the usual activities and routinary work of the Serv- 
ice were carried on during the year, it was found possible to 
effect but few permanent sanitary improvements, as the per- 
sonnel had to devote most of their time and efforts to combating 
the epidemics with which the year was fraught. Indeed, the 
year 1918 turned out as a specially bad year from the stand- 
point of epidemiology, and never in the history of the Service, 
excepting perhaps the cholera years of 1902 and 1903, had its 
resources been so heavily taxed. Yet, disastrous as the epide- 
miological record of 1918 has been — and in this respect, the rest 
of the world was not better off, as influenza was distributed 
evenly in all continents and islands — it will probably serve a 
good turn in that it clearly brought out in relief such organic 
deficiencies as needed correction and improvement. 

VITAL STATISTICS. 

The noteworthy feature of the year from the standpoint of 
vital statistics was the overdraft caused on the expected annual 
increment of population by the influenza epidemic, the mortality 
from which numbered about 85,000 in all. In a minor degree, 
the epidemic of smallpox and the cholera outbreaks, on the one 
hand, and on the other, the increased general mortality rate from 
other diseases, and the deaths from malaria and pulmonary tu- 
berculosis, helped to swell the total number of deaths to the 
extent of causing a natural decrement of 12,921 in the popu- 
lation during the year 1918. The comparative vital statistics 
for 1917 and 1918 are given below: 

8 



Year. 



1917- 
1918 



Mortality. 



Births. 



Total 
deaths. 



213. 778 
349,036 



I , 



Rate per ' 

1.000 i 



22.32 ! 
41.73 i 



Total 
births. 



349,842 ! 
336, 115 j 



Fluctua- 
tion of po- 
j pulation. 

Rateper J^Jl'. , ^ 
1,000 create i + J. 

crease ( — ) 



20. 33 
29.36 



+ 136,064 
— 12,921 



PERSONNEL. 

Surgeon John D. Long, U. S. Public Health Service, resigned 
his position as Director of Health for the Philippine Islands, 
effective December 31, 1918, the undersigned assuming charge 
as Acting Director of Health on January 1, 1919. 

The commissioned personnel was considerably depleted during 
the year, through resignations, retirement, death, and the mili- 
tary exigencies of the occasion. The clerical force was likewise 
sorely handicapped by the lack of men. The provincial organi- 
zation did not escape a similar experience. The shortage of 
personnel got to such a point as to threaten the organic frame 
of the Service, and it was only the splendid spirit of the men 
who were left and did, in addition to their customary duties, 
the work of those who had temporarily or permanently gone, 
that saved the Service from actual disorganization. 

Seven commissioned officers and the Director of Health, Dr. 
John D. Long, resigned during the year. The exigencies of 
war took two chiefs of office, ten men from the commissioned 
personnel and six presidents of municipal sanitary divisions 
from the provincial organizations. In the case of the commis- 
sioned personnel, the subtraction of so large a percentage from 
the total available number caused a serious handicap in routine 
health work, the more serious because commissioned officers are 
the men who supervise all work done in connection with the 
eradicating of communicable diseases. 

The depletion of personnel in the higher grades and our fail- 
ure to fill up gaps in the lower proved to be matters of serious 
concern. The depletion in the lower grades, subsisting as it does 
to this date, has become a veritable problem requiring prompt 
solution. The depletion in the higher ranks was a by-product 
of the provision of the Salary Law curtailing private practice 
from officers drawing ^3,000 or more per year, a provision 
which, by the way, we would be pleased to see extended and 
made applicable to all grades, as it is nothing but the legal ex- 
pression of the full-time system. Others, though, left the Ser- 
vice on account of the exigencies of war. Our failure to fill all 
the vacancies in the lower grades was due, on one hand, to the 



5 

low standard of salaries provided for such positions and which 
has prevailed in the Service for years, and on the other, because 
of apparent shortage of men willing to pursue sanitary work 
as a vocation. While we realize that the financial condition of 
the country does not admit but expenditures of the most urgent 
and necessary character, yet in view of the recent developments 
of sanitary science and administration elsewhere, of the in- 
creased expenditures consequent thereto and resulting from the 
Great War, and of the fact that the interests of public health 
are of vital import to the country, webbed as they are with the 
social, industrial and political fabrics of society, it is believed 
that public health work in the Philippines, if it is to be kept 
abreast of modern progress, must needs be allowed ample appro- 
priations with which many needed improvements, such as the 
raising of the salary standard, may be affected. Certain amend- 
ments in the Salary Law such as curtailing private practice and 
allowing better pay in the lower grades of the Service, and 
providing for other contingencies, would then be in order. The 
above will undoubtedly result in added efficiency as it will enable 
us to offer better pay and allurements to likely young physicians 
who may wish to devote their lives to health work; existing 
vacancies may be readily filled; the services of competent men 
may be secured; and the benefits of the full-time system may 
then be extended to all grades of the Service including the pres- 
idents of municipal sanitary divisions. 

RESIGNATIONS. 

John D. Long Director of Health. 

Gilbert I. Cullen Senior Medical Inspector. 

Arlington Pond Senior Medical Inspector. 

Claude E. Norris Senior Medical Inspector. 

Domingo Santos Senior Surgeon. 

Andres Bautista , Senior Surgeon. 

Guillermo Jimenez Surgeon. 

Jose Chavez Surgeon. 

RETIREMENT. 

Zach M. Laughlin Senior Medical Inspector. 

DEATH. 

Paul Clement Chief, Division Provincial sanita- 
tion; died June 20, 1918. 

SERVED WITH U. S. ARMY. 

Paul Clement Chief, Division Provincial sanita- 
tion; died June 20, 1918. 

Arlington Pond Senior Medical Inspector. 

Almon P. Goff Senior Medical Inspector. 

Henry Pick Senior Medical. Inspector. 



SERVED WITH PHILIPPINE NATIONAL GUARD. 

E. L. Barber Sanitary Engineer. 

M. J. Walsh Chief, Clerical Force. 

Pacifico Laygo Senior Surgeon. 

Jose Raymundo Senior Surgeon. 

Enrique F. Ochoa Senior Surgeon. 

Benito Panganiban . Surgeon. 

Manuel Arguelles » Surgeon. 

Juan Crisologo Assistant Surgeon. 

Ramon Santa Ana President, Sanitary Division. 

Pedro Buenaseda President, Sanitary Division. 

Virgilio Gonzalez President, Sanitary Division. 

Rafael Perez President, Sanitary Division. 

Caspar Garcia President, Sanitary Division. 

Eliseo Bundoc President, Sanitary Division. 

EPIDEMIC DISEASES. 

The occurrence of two extensive epidemics — influenza and 
smallpox — constituted the salient epidemiological features of 
the year. Almost coincident at the time of appearance, both 
caused heavy tolls in life, smallpox, throughout the year, while 
influenza did its worst during the last quarter. 

INFLUENZA. 

Insidious in its beginning — the first cases believed to have 
occurred about the end of April, it became recognized as an 
epidemic during the months of May, June, and July. At this 
time, however, the disease appeared in mild form, and caused 
but slight mortality, if any. It was, however, but the fore- 
runner of a second epidemic wave, which beginning to manifest 
itself about the end of September, developed distinct epidemic 
tendencies in October and swept over the whole Archipelago 
from Aparri to Sulu during the rest of the year. The acme 
of the second epidemic was reached at about the middle of No- 
vember, the downward curve taking place at the beginning of 
December. At the close of the year, the disease had lost its 
epidemic character and was present only as scattered cases in 
out-of-the-way localities to where the epidemic was belated in 
coming. 

The rate of incidence of the two epidemic waves was about 
the same, 40 to 45 per cent of the population of the islands being 
affected. The mortality rate, however, difl'ered greatly, the 
first causing but few fatalities if any, while the second exacted 
about 85,000 deaths in all. It was impossible to keep tab of 
the actual number of cases, but it is believed that the general 
mortality was about 1.8 per cent. Most of the deaths were due 
to respiratory, cardiac and renal complications. 



SMALLPOX. 





Locality. 


Cases. 

1.326 
33, 092 
12.951 


Deaths. 


Rate of 
incidence 
per 1,000 
popula- 
tion. 


Average 
mor- 
tality. 


City of Manila _ 


869 
14,092 
1,486 


4.4 
4.5 
4.2 


Per cent. 
65.3 


Provinces 


39.8 


Mindanao _ 


11.4 








Total . -_ 


47,369 


16, 447 


4.3 


38.8 









Smallpox was present during the year in epidemic form. 

In this connection, it is to be noted that, although smallpox 
was reported during 1916 and 1917 ^from the provinces of Sa- 
mar and Leyte and from Davao, Mindanao, the city of Manila 
and the rest of the provinces enjoyed immunity from small- 
pox since the general Vaccination of 1905 and 1906. For the 
last two years, however, a notable increase in cases of varioloid 
had been noted, and this Service had pointed out that the im- 
munity conferred to the population by the previous general 
vaccination had begun to wane. 

Plans were made to start a general revaccination of the pop- 
ulation. As a matter of fact, vaccination was carried rather 
extensively during 1917 in the city of Manila and in the prov- 
inces, particularly in those provinces which were among the 
first to be vaccinated. 

The disease was introduced into Manila, so far as we know, 
as follows: 

The first case of the outbreak occurred in a Moro from Pala- 
wan who had been shipwrecked, rescued and brought to the city 
to be returned to his home island, and was found sick December 
16, 1917. On January 1, 1918, his son who accompanied him 
was also found to be sick and later died on January 10th; the 
next case occurred on Calle Florida, origin of infection undis- 
coverable ; the next case occurred in an insane person sent from 
Surigao on January 28, 1918; the following date another case, 
origin unknown, was also found on Calle Elcano. 

The above infections of unknown origin, as well as many 
others that subsequently occurred, it is believed, came from 
those provinces and towns, some of them nearby, where small- 
pox had existed for some time without report of its existence 
till the disease appeared in Manila, thus making its presence 
known and causing house-to-house search for cases to be made 
with the resulting discovery of many hidden and unreported 
cases. 

The smallpox epidemic reached its climax during April, May 



8 

and June, and was practically brought under control during 
July. Since then, only sporadic cases occur in the city of Manila. 

The infection in the provinces around Manila and elsewhere 
developed in concentric lines and followed the highways of 
commerce, with Manila as a center focus. 

The following provinces were infected in the order given 
below : 

February — Rizal. 

March — Bataan, Bulacan, Cavite, Laguna, Nueva Ecija, Pam- 
panga, Pangasinan, Tayabas. 

April — Batangas, Ambos Ilocos. 

May — Mindoro, Nueva Vizcaya, Romblon, Zambales. 

June — Antique, Cebu, Capiz, Bohol. 

From July to the month of August the epidemic swept over 
the rest of the provinces. At the end of the year 21 provinces 
remained infected with smallpox. 

In the Department of Mindanao and Sulu, with the excep- 
tion of the Provinces of Sulu and Bukidnon, all the provinces 
comprised within the department were invaded by smallpox. 
In Davao, Lanao and Zamboanga, the epidemic was but a con- 
tinuation of the 1917 outbreaks. The infection in Misamis and 
Surigao was traced to Cebu. The infection in Cotabato was 
traced to Lanao. At the close of the year, the Provinces of 
Cotabato, Davao, Misamis, Surigao, and Zamboanga remained 
infected. 

A striking feature of the outbreak was the preponderance 
of children among those attacked. In Manila, 72 per cent of 
the patients were under 15 years of age and 85.9 per cent were 
in children of from fifteen days old to and including ten years 
of age, the remaining 14.6 per cent including all ages from 11 
years up. Approximately the same percentages for age groups 
obtained in the provinces. 

The smallpox situation, while grave, was never out of con- 
trol. Emergency hospitals were established where needed, as 
rapidly as possible, and they served to reduce the mortality and 
to retard the spread of the disease. Vaccination was pushed 
vigorously by all agencies concerned — insular, provincial and 
municipal, and while it will undoubtedly take some time before 
the disease entirely disappears, it is certainly declining under 
the measures taken, and another long period of immunity will 
be had, followed by small recrudescences until the people gen- 
erally will have learned by repeated experiences, that complete 
immunity can only be attained by constant, persistent and re- 
peated general vaccinations of everyone, not only for individual 
protection but for the protection of the entire community. 



9 

OTHER COMMUNICABLE DISEASES. 

CHOLERA. 

The disease was present throughout the year in sporadic and 
epidemic forms in Manila and in thirty-one provinces, includ- 
ing six comprised within the Department of Mindanao and Sulu. 

While the infection was rather heavy in the Provinces of 
Bohol, Pangasinan, Cebu, Batangas, and Iloilo, the situation, 
however, never assumed the proportions of a wide-spread epi- 
demic. In all instances, the outbreaks were promptly brought 
under control. 

The incidence and mortality from the disease during the year 
was as follows : 

Cases. Deaths. 

City of Manila 182 123 

Provinces 6,236 4,605 

Mindanao and Sulu 2,565 1,612 

Total 8,983 6,340 

The year's outbreaks of cholera were but a continuation of 
the series of outbreaks which succeeded each other from as far 
back as August, 1913, when cholera made again its appearance 
in the islands after an apparent absence of almost two years. 
From the best information obtainable, there was no known 
case of cholera anywhere in the Philippine Islands since Octo- 
ber, 1911, but since a careful investigation failed to show that 
the disease was introduced from a foreign country, we are led 
to believe that the outbreaks during 1913 in Manila and in the 
Provinces of Bataan, Bulacan, Cavite, Capiz, Cebu, Pampanga, 
Pangasinan, and Rizal, were of endemic origin. 

The cholera problem in the Philippines bears many points 
of resemblance with the typhoid problem in the United States, 
in that in either country, either disease has become endemic 
and has never been eradicated, although always held in check. 
The typhoid outbreaks in America are of the same general 
characteristics as those of cholera outbreaks in the Islands, 
from the standpoint of epidemiology, the factors responsible 
for their propagation being the following: 

(a) Water, milk and food supply. 

(6) Fomites, or objects contaminated with infective material 
or excreta from patients. 

(c) Flies. 

(d) Improper sewage or fecal disposal. 

(e) Filthy habits. 
(/) Actual cases. 



10 

(g) Carriers, as factors of propagation as well as of explo- 
sion. 

So far as the outbreaks of cholera during the year are con- 
cerned, we considered the cholera carrier as the most important 
factor concerned in the explosion, transmission and propaga- 
tion of the disease, and consequently efforts were made for their 
detection, isolation and treatment. Although a few local out- 
breaks have assumed fairly large proportions due to secondary 
contamination of the water and food supplies, the outbreaks 
were in the main, carrier-borne or spread by contact infection. 

Aside from the above factors, responsible for the transmis- 
sion and propagation of cholera, there were others which played 
an important part in connection with the outbreaks not in re- 
lation with the transmission of the disease, but in that they 
increased the individual susceptibility to the infection, viz : 

(a) Lowered bodily resistance of the general population super- 
imposed by the influenza epidemic, a fact that was borne out 
by the increased general mortality from other diseases through- 
out this land. 

(6) Errors in diet brought about by the scarcity and high 
cost of foodstuffs, predisposing the general population to gastro- 
intestinal disorders. 

(c) Last, but not least, the fact that the volume of traveling 
and intermigration between islands, between provinces, and 
between the city of Manila and outlying localities have con- 
siderably increased during the last few years due to increased 
transportation facilities. There is therefore an endless inter- 
mingling of people from infected to noninfected places and an 
incessant flow of cholera carriers from one end to the other end 
of the islands. 

In passing, it is to be stated that the total eradication of 
cholera from these islands is a possibility for the future but 
not for the present. Our means and ways for combating the 
disease have been brought, however, to a point where extensive 
epidemics may be precluded and local outbreaks or "flare-ups" 
are speedily brought under control. Under the circumstances, 
our ideal in cholera work is abridged under two heads: 

(a) Control of outbreaks. 

(6) Reduction of incidence of infection to the minimum. 

TYPHOID FEVER. 

A total of 3,817 deaths, as against 2,144 registered during 
1917, were reported from the provinces. The incidence rate 
in the provinces registered an increase of 79.46 per cent over 
that of last year. The record in the city of Manila was, how- 



11 

ever, better. A total of 497 cases and 118 deaths were reported 
for the year as against 525 cases and 199 deaths for the year 
1917. There was also a decrease in the mortality rate, 1918 
registering 23.74 per cent mortality against 37.9 for 1917. The 
improvement of the typhoid situation in Manila was traceable 
to thorough and accurate reporting of the cases, which, of 
course, brought about a far more satisfactory disposal of the 
ill — better home isolation, if not hospitalization of the cases, 
continuous concurrent disinfection of the patient's discharges 
and other precautions as regard food and drink, and the pre- 
vention of contact infection. 

DYSENTERY. 

The total number of deaths reported from the provinces was 
8,973 as against 7,092 in 1916 and 7,496 in 1917. In the city 
of Manila, a slight decrease from the record of 1917 was noted, 
839 cases and 218 deaths for 1918 as against 851 cases and 
294 deaths for 1917. The same explanation given for typhoid 
fever may be offered in this connection, the two diseases being 
water-borne and of similar epidemiological character. 

DIPHTHERIA. 

Seventy suspected cases were reported in the city of Manila. 
Of these, two cases and one death were found clinically and 
bacteriologically positive. Forty-three cases and fourteen 
deaths were found clinically positive, so a total of 45 cases 
and 15 deaths were found positive, from the clinical standpoint. 

As in the case of last year, two epidemiological points in 
connection with diphtheria outbreak in Manila remain as yet 
unsolved, viz: 

(1) The high mortality obtaining both in positive and nega- 
tive cases, even with the administration of curative doses of 
diphtheria antitoxin. 

(2) The participation of other non-specific factors in the 
causation of the disease. 

No cases reported from the provinces. 

TUBERCULOSIS. 
Tuberculosis is increasing every year. During 1918, the di- 
sease caused more deaths than cholera, dysentery and typhoid 
put together. A comparative statement of deaths in the prov- 
inces from tuberculosis during the last three years is given 
below : 

1916 17,411 

1917 17,882 

1918 : 20,498 



12 

An increase of 14 per cent was therefore recorded for 1918 
over 1917. 

MALARIA. 

With tuberculosis, malaria shares credit for the largest num- 
ber of deaths caused. As in the case of tuberculosis the in- 
cidence and mortality rates are increasing year after year, as 
may be seen on the following statement of deaths for the last 
three years : 

1916 25,862 

1917 28,697 

1918 43,520 

PLAGUE. 

No case of either human or rat plague registered during 1918 
anywhere in the Philippines. The last known case of human 
plague in the islands occurred September 12, 1914, and the last 
case of rat plague was found in 1916, the same being of chronic 
avirulent type. 

SANITATION IN THK CITY OF MANILA. 

The routine work of the division was carried on with the 
same dispatch and thoroughness of former years. However, 
the influenza and smallpox epidemics and the cholera outbreak 
gave the personnel particularly heavy work. All responded 
eagerly to the needs of the occasion and there was every reason 
for commending their splendid behavior. 

The following were the noteworthy epidemiological features 
of the year: 

(1) The occurrence of the influenza and smallpox epidemics. 

(2) The increase noted in the general mortality as a conse- 
quence of the influenza epidemic 

(3) Certain peculiarities noted in the cholera outbreak of 
October and November, such as a mortality percentage higher 
than that noted in previous outbreaks; a large percentage of 
clinically positive cases but found ''negative'' bacteriologically ; 
and failure to note an increase in the number of carriers prior 
to the appearance of cholera contrary to what has been observed 
in previous outbreaks, said departure from the ordinary known 
course of cholera believed to have been influenced by the grippe 
epidemic. 

SANITATION IN TIIF PROVINCES. 

The greater portion of the activities of the provincial health 
organizations had to be assigned perforce to eradication work 
in connection with the smallpox and influenza epidemics, and 



13 

the cholera outbreaks which were rather numerous during the 
year. On the above account, it was found impossible to under- 
take sanitary improvements of permanent character nor was it 
humanely possible as a consequence thereof to effect anything 
more than mere routine and communicable disease eradication 
work. 

The matter of efficiency of the medical personnel on half-time 
schedule has been put to acid test during the various epidemics, 
and to be candid, in most instances, the services of such officers 
have been found wanting. The matter has reached a point 
where it becomes necessary to do away with the old system, if 
the Service is to have efficient men in the provinces. Full-time 
officers became the cry of the year as it has been from years 
back. The old system of half-time men is faulty in that it rests 
upon a false basis of service. A physician is either a sanitarian 
or a practicing man. He cannot be both at the same time. That, 
and the fact that a half-time medical officer is poorly paid ac- 
counts for the deficient services rendered. It would appear then 
as though the time has come for extending the full-time system 
to presidents of municipal sanitary divisions and to allow them 
better pay, so that there would be no need for them to do private 
practice. Such a course would seem to be about the very best 
we could do to insure the efficiency of our provincial health 
organizations. 

SANITATION IN MINDANAO AND SULU. 

All the provinces included within the Division have been or- 
ganized into sanitary divisions. The general provisions of the 
Public Health Law have been made applicable to all the provinces 
of the Department. Surigao was the last to be organized into 
sanitary divisions. 

The sanitary divisions have all been provided with qualified 
physicians. For the first time in their history, the towns along 
the Pacific coast, where the people have never before seen phy- 
sicians, are now receiving the benefits of a health organization. 

During the year the number of closets of the Antipolo sewage 
system increased to 1,000 per cent. The number of dispensaries 
in operation at the end of the year remained equal to the num- 
ber during 1917. At Zamboanga, a new general hospital and 
a hospital for contagious diseases were inaugurated during the 
year. 

HOSPITALS. 

At the close of the year, a total of seventeen hospitals were 
in operation under the control of this Service, two of which are 
located at Manila^ and the others in the following towns and 



14 

cities: Albay, Baguio, Bayambong, Bontoc, Butuan, Cotabato, 
Cuyo, Dapitan, Iwahig, Jolo, Kiangan, Lanao, Naga, Tacloban, 
and Zamboanga. Totals of attendance, treatments and deaths 
in these hospitals, Bilibid and San Lazaro and the Culion Leper 
Colony excepted, are given below: 

Total number of patients on hand, January 1, 1918 125 

Total number of patients admitted during 1918 7,573 

Total number of patients treated during 1918 7,698 

Total deaths 264 

Mortality rate per cent.... 3.41 

SANITATION BILIBID PRISON. 

The chief causes of mortality among the prisoners at Bilibid 
were pulmonary tuberculosis, intestinal parasites, amoebiasis, ve- 
nereal diseases among the new arrivals, contagious eye diseases, 
grippe and respiratory diseases. 

In a total of 16,476 stool examinations performed during the 
year in connection with the intestinal parasites survey, 4,634 
were found positive for intestinal parasites distributed as follows : 

Ascaris lumbricoides 2,409 

Hookworm 1,636 

Amoeba coli 558 

Amoeba histolytica 21 

Taenias 10 

The proportion of the prison population found infected with 
parasites was 29.94 per cent, or a little less than one-third. Of 
those found harboring parasites, 51.96 per cent, or a little over 
one-half were found infested with round worms, 35.30 per cent 
afflicted with hookworm, 12.04 per cent with amoeba coli, 0.4 per 
cent with amoeba histolytica and 0.21 per cent with taenia. 

Bilibid Prison was free from cholera during the entire year. 
Out of 91,999 cultures taken and sent to the Bureau of Science 
for examination only one man was found to be a positive cholera 
carrier. This comparative immunity of the institution from 
cholera infection was due to the stringent measures taken by 
the prison officials to prevent the entrance of infection from 
outside, and to the strictly hygienic way in which the prisoners 
were fed. 

Twelve cases of beriberi were treated during the year, most 
of these cases having occurred amongst new comers or prisoners 
working outside and in the provinces. The use of unpolished 
rice has greatly diminished the incidence of this disease in Bili- 
bid Prison during the past few years. 

During the influenza epidemic of October and November, al- 
most all of the inmates of the prison fell victims to the disease, 



15 

and of those in whom respiratory complications developed, nearly 
half died. Among the 2,674 cases of this disease treated during 
the year, 71 cases of lobar pneumonia complications occurred 
with 31 deaths. 

As in the case of the previous year, tuberculosis continues 
to hold first place in the morbidity and mortality among pris- 
oners. Out of 179 cases treated during the year, 108 or 65.95 
per cent died. The transfer of tuberculosis patients to Iwahig 
Penal Colony, or elsewhere would improve the health of such 
patients and prevent the spread of infection inside Bilibid Prison. 

As a result of the influenza epidemic, the general death rate 
and the death rate from tuberculosis showed marked increase 
as compared with the rates of previous years. 

In the annual general medical survey of the prison, 2,633 
prisoners, including females, were examined physically and mi- 
croscopically, and the results of the examination was as follows : 

Skin diseases 876 

Eye diseases 147 

Mouth and tooth diseases 334 

Hemorrhoids 59 

Hydrocele 19 

Hernia 15 

Fistule Ani 5 

Lipome 32 

Varicocele 19 

Varicose veins.... 16 

Cataract 3 

Phymosis (congenital) 4 

Harelip 1 

Incidentally, 39.08 per cent of the prisoners so examined were 
found infested by intestinal parasites, a higher percentage than 
the one given at the beginning of this article. 

The general death rate for the year was 21.10 per 1,000, 
figured on an average prison population of 6,926 ; of which 10.40 
represent deaths due to non-tubercular cases, and 10.70 represent 
those due to pulmonary tuberculosis. Of the total 146 deaths 
occurring during the year, 137 were Filipinos, 8 Chinese and 1 
American. 

The comparative immunity of Bilibid from cholera infection 
and the very small number of cases of beriberi registered during 
the year, most of which were traceable from outside at that, 
are convincing proofs of what iron-handed sanitation can accom- 
plish in a given group of individuals. Our experience in sani- 
tation work at Bilibid Prison is a standing lesson of tropical 



16 

sanitation; even our failures there serve as valuable pointers 
for future guidance in health administation. 

SAN LAZARO HOSPITAL. 

This institution is of all the hospitals in the islands, the only 
one exclusively reserved for the care, isolation and treatment of 
dangerous communicable diseases. Although, it ranks as being 
one of the largest and most important institutions in the country, 
yet its capacity was found by far insufficient to accommodate the 
patients who were transferred there during the cholera, small- 
pox and influenza epidemics. 

A total of 4,803 admissions were registered during the year, 
of which 401 were cholera patients, 1,079 smallpox, 860 varioloid. 
460 measles, 650 tuberculosis, 302 leprosy, 326 insanity, 169 dy- 
sentery and 162 mumps. The balance were admissions for other 
communicable diseases. Of those brought to the hospital for 
treatment, 1,180 had fatal termination, a little less than one-half 
of whom died from smallpox. 

With regard to permanent structural improvements needed in 
this hospital, and there are many recommended for 1919, the 
reader is referred to the Report of the Division of General In- 
spection and Hospitals dealing on San Lazaro Hospital. 

CULION IjEPER colony. 

The following permanent improvements were effected in the 
colony during the year : 

(a) The construction of a protestant chapel. A modified 
'^model-house'' style of architecture. 

(6) The completion of the Culion Lreper Club house. Building 
is also of *'model-house'' style. 

(c) The Leper School-house to replace the one condemned and 
torn down sometime' ago, was started in March and now com- 
pleted. Also of "model-house'' style and with capacity for 500 
students. 

(d) The new Imhoff tank which was started last year and 
now completed, but as yet unused. 

(e) Construction of the sanitary barrio continued during the 
year. 

(/) Construction of a medicated bath house. Building of 
"model-house" style with capacity for six bathers. 

(g) Electric Light Plant. The Culion Fish and Ice Company 
incorporated itself as the Culion Ice, Fish and Electric Company 
and installed an electric plant which supplies excellent lights 
to both the Colony and Balala. 



17 

At Balala, the non-leper section, permanent improvements 
were also effected, viz. : 

(a) The Chiefs House, — Erection started in 1917 was com- 
pleted and occupied in April, 1918. Building is of modified 
'^model-house'* plan. 

(6) Clerk's quarters. — A new double house of the "model- 
house'' plan has been erected providing ample accommodations 
for two families. 

(c) Dock bodega. — A temporary structure has been erected, 
made of first group timbers with galvanized iron roof. 

{d) A new launch, thirty feet, ''V-bottom," all lanete, was 
constructed early in the year and fitted with a new 25 horse 
power Ferro engine. The launch has proved very seaworthy. 

CLERIC AIj work. 

The work of the Clerical Office has been particularly heavy 
during 1918. The daily average of pieces of mail handled had 
increased to an enormous extent, and a serious shortage in the 
personnel was experienced throughout the year, more acutely so 
during the second semester, when the chief of office had to be 
absent himself undergoing military training with the Philippine 
National Guard. As a whole, though, the available personnel 
performed their tasks satisfactorily despite shortage of numbers 
and consequent doubling up of work. 

PUBLIC HEALTH NURSING. 

Work by public health nurses in Manila has been in the main 
along educational lines, and in connection with child welfare, 
medical relief and general hygiene and sanitation. The plan 
was to visit each house in a given district and treat the simple 
cases, referring the more serious ones to hospitals and clinics. 
Talks were given in each house on sanitation, housekeeping and 
balanced diet, expectant mothers were advised and instruction 
given in the care of babies. Emphasis was given to the subject 
wherein education was apparently most needed in the household. 
The family was also instructed in the care of the sick and in 
the prophylaxis against infectious diseases. The work in the 
provinces has been done in accordance with the same plan. 
Practical demonstrations of public health nursing work were 
given to the nurses of the hospitals at Baguio, Bontoc, Kiangan 
and Bayombong and instructions to the people in the villages 
along the trail between these towns. The office has also cooper- 
ated with the sanitary surveys in Cebu and Bulacan Provinces 
and with the sanitary work in the extra cantonment zone around 

168426 2 



18 

Camp Claudio. A tabular report of the activities of public health 
nurses is given below : 



Localities, 



Manila 

Provinces- 



First 
visits. 



4,936 
2.349 



7,285 



Follow- I 

up 
visits, i 



4,856 
547 I 



5,403 



Treat- 
ments. 



5,715 
1,076 



Referred 

to 
clinics. 



94 



School children. 



Female 

1 shop- 

I I keepers 

Exam- Treated ^^^^^l^^^ 
ined. ireatea. and m- 
structed. 



6.791 



768 
768 



265 
265 



AUTOMATIC HEALTH CONTROIi. 

In the annual report for 1917, it was intimated that "a future 
benefit (of sanitary commissions) of far-reaching importance 
will be the installation of a system of health organization in 
sanitary divisions which for want of a better name, has been 
tentatively designated the automatic health organization/' This 
system consists, briefly, in a series of maps, curves and charts, 
card indexes and cross indexes, based upon data which have been 
obtained through the work of the Sanitary Commisions, and 
which will be installed in each sanitary division as rapidly as 
may be possible. Once this type of organization is established, 
it will be possible for the health officer to know at once what 
particular factor ife bringing about an increase in morbidity and 
mortality and it will indicate with a reasonable degree of exact- 
ness the probable origin of the infection which is producing the 
morbidity and mortality. A little further and more detailed 
investigation will then enable the health officer to locate the 
cause with certainty. 

The system has been actually tried during the year in the Prov- 
inces of Cebu and Bulacan. The results have far surpassed our 
expectations as to the practical benefits to be derived from the 
system, and it is planned to extend same to every province be- 
ginning January 1, 1920. 

A bulletin on the subject of automatic health control has been 
prepared by Dr. L. R. Thompson, Passed Assistant Surgeon, 
U. S. Public Health Service, under the direction of the Director 
of Health. Dr. Thompson, by the way, is the man who conceived 
the idea that finally resulted in automatic health control. 

EXTRA CANTONMENT ZONE WORK IN AND AROUND CAMP 

Cli AUDIO. 

Upon the mobilization of the Philippine National Guard at 
Camp Claudio, Rizal Province, His Excellency, the Governor- 
General promulgated Executive Order No. 38, with a view to 



19 

protecting said organization against dangerous communicable 
diseases. Under the provisions of this order, the Secretary of 
Public Instruction approved a set of sanitary regulations sub- 
mitted by the Philippine Health Service to cover the following 
subjects : 

1. Short title of regulations and administrative jurisdiction. 

2. Ordinance providing for the prevention of dangerous com- 
municable diseases. 

3. Ordinance providing for adequate reporting of health sta- 
tistics. 

4. Ordinance providing for the maintenance of school sani- 
tation. 

5. Ordinance providing for the supervision of sanitary main- 
tenance of premises. 

6. Ordinance providing for the abatement of nuisances. 

7. Ordinance making members of police department sanitary 
inspectors for abatement of nuisances. 

8. Ordinance providing for the disposition of human wastes. 

9. Ordinance providing for the care and disposal of manure. 

10. Ordinance providing for the disposition of garbage, refuse 
and ashes. 

11. Ordinance providing for the prevention of mosquito 
breeding. 

12. Ordinance providing for the protection of the domestic 
and drinking water supplies. 

13. Ordinance governing the sale of food and drink. 

14. Ordinance providing for the sanitary regulation of barber 
shops and hair dressing establishments. 

15. Ordinance providing for the prevention of venereal dis- 
eases. 

16. Ordinance requiring the muzzling of dogs. 

Through the provisions of the above regulations the Philip- 
pine Health Service created, under date of November 4, 1918, 
an extra cantonment zone within a circle the radius of which 
was seven miles from Camp Claudio. The district was placed 
in charge of Senior Surgeon Felino Simpao, and included the 
towns listed below: Pasay, Paraiiaque, Las Pinas, Muntinlupa, 
San Pedro Makati, San Juan del Monte, San Felipe Neri, Pasig, 
Pateros, and Tagig in Rizal province ; Bacoor and Imus in Cavite. 

The zone included a population estimated to be 107,914. 

Sixty-four artesian wells are scattered in the district. The 
average number of population using this source of water supply 
is 1,686 per each well. Despite the above, only 91 cases and 62 
deaths due to water-borne diseases were registered. It is be- 



20 

lieved that the rigid inspection of shops where food was sold 
has been instrumental in bringing the incidence and morbidity 
from such diseases to low figures. 

Six thousand sixty-seven cases and 935 deaths from commu- 
nicable diseases were registered, most of which were due to in- 
fluenza, the towns of Imus, Pasig and Paranaque being the 
greatest sufferers thereof. The municipality of Tagig registered 
77 cases and 46 deaths from smallpox. 

To the end that the above morbid causes may be checked and 
the National Guard cantonment rendered free from contagious 
diseases, the extra cantonment health service effected activities 
along the lines listed below: 

(a) Lectures on preventive measures against dangerous com- 
municable diseases. 

(b) Influenza campaign. Treatment of cases found and re- 
ported by sanitary inspectors and distribution of medicines. 

(c) Distribution of anti-influenza bulletins. 

(d) Inspection of 21,360 houses and sanitary orders issued 
for general cleaning. 

(e) Weekly inspection of public schools and monthly physical 
examination of school children. 

(/) Sanitation of populated centers especially those lying 
around Camp Claudio. 

(g) Disinfection of houses where cases of dangerous diseases 
have been registered. 

(h) Disinfection of 40 surface wells. 

(i) Partial vaccination. 

(;) Construction of six public midden sheds. 

(k) Construction of 1,956 closets of the Antipolo system. 

(0 Sanitation of 486 stables and providing of same with ab- 
sorbent tanks. 

(m), Inspection of all tiendas, 440 of which were placed in 
sanitary condition. 

(n) Sanitary supervision of establishments for the sale of 
candy and ice cream. 

(o) Poisoning of 307 stray dogs. 

(q) Statistical work in the municipalities of Pasay, Para- 
naque, Las Pinas, Bacoor, and Imus for automatic sanitary 
control. 

NEW DEVEIiOPMENTS IN SANITARY SCIENCE. 

CAMPAIGN FOR BALANCED DIET AND HEALTHIER HOMES. 

Public health is in a state of change. New developments 
are continously taking place, and as consequence of such changes, 



21 

a revision of our old views is made necessary. The funda- 
mental change from the old consists in a shift of attention from 
the inanimate surroundings of man to the man himself. Pre- 
vious generations of public health propagandists had been so 
intent on the importance to the individual of his health that 
they quite overlooked the immense importance in arriving at 
the climax — health — of those factors involved in the individual : 
his make-up, his vigor, his alertness, his enterprise, his physical 
adaptability; his faculty for meeting adverse conditions leading 
to disease. 

So far as the application of these new views in the Philip- 
pines is concerned, the shift would appear indicated, primarily 
toward conservation of and caring for the individual's resistance 
to disease, and secondarily toward securing healthful surround- 
ings for the individual. 

Dr. John D. Long, during his tenure of office as Director of 
Health for the Philippine Islands, pointed out the way leading to 
the above objective points. His efforts to secure a better diet and 
healthier home surroundings for the average Filipino are now 
not only a matter of record, but of actual realization. The idea 
thus sown has spread, and the results of the hygienic campaign 
for securing a balanced diet undertaken during the year with 
the cooperation of the women's clubs have in the whole been satis- 
factory, as evidenced by the number of the vegetable gardens 
established, the improved standard of living observed among 
those who have been reached by our efforts and the general 
improvement of the family, social and economic standards of 
these same people. There is, however, a great deal yet to be done 
in this regard, as the bulk of the masses have yet to be reached. 
There is also the natural inertia of long-established customs 
to be met, the hardest stumbling block perhaps with which we 
will have to contend with in this regard. 

The problem of housing — the individual's surroundings — has 
been also a subject of our attention, alongside of such side fea- 
tures of the home as sanitary sewage disposal, domestic hygiene, 
sanitation of yards and premises, water supply, etc. There has 
been a fairly general acceptance and adaptation of the Service's 
sanitary-house plan. The work is vast, though, and involves 
social and economic problems, without proper solution of which 
we can secure at best but mediocre results. But the way has 
been blazed, and with '^better food and healthier homes" as a 
slogan, this Service is hopeful of fully meeting these later de- 
velopments of modern sanitary science in the years to come. 



22 

SUMMARY OF WORK IN 1918. 

A. SANITARY WORK IN THE PROVINCES. 

(a) The automatic health control system has been actually 
tried in two provinces and practical results obtained far sur- 
passed expectations. 

(6) Six additional provinces — La Union, Mindoro, Nueva 
Ecija, Pangasinan, Rizal, and Sorsogon — organized into sani- 
tary divisions. 

(c) One hundred sixty-five new dispensaries established, 
making a total of 562 in operation at close of year, serving over 
380,000 people. 

(d) A new general hospital and a new contagious hospital 
opened in Zamboanga. 

(e) Work done in public health nursing consisted of attend- 
ance to 224 abortion cases, 2,845 normal deliveries, 157 dys- 
tocias, and 732 post partum cases. Feeding of 5,767 babies 
under 2 years supervised; 1,158 public and 9,289 private lec- 
tures were given. 

(/) Thirty-eight thousand four hundred fifty-four closets of 
the Antipolo sewage system installed. 

(g) Three hundred sixty-one artesian wells drilled; 2,706 
sanitary surface wells dug; 9 gravity systems installed. These 
and those already in operation at beginning of year provide 
water for 37 per cent of the population. 

(h) Sixty-three markets built. 

B. SPECIAL SANITARY AND HYGIENE ACTIVITIES. 

(a) Education and publicity, as promoted by a biweekly 
bulletin distributed to all parts of the Islands, and printed in 
the daily papers. Also pamphlets and exhibitions, lectures and 
moving pictures work. Attendance to lectures 267,644 persons. 

(6) Improvement of structural specifications of the average 
Filipino home. Much interest has been stimulated in this move- 
ment and there has been fairly general acceptance and adapta- 
tion of the Service sanitary-house plans. 

(c) The foundation of 167 new women's clubs, making 233 
in all. This is the most effective measure yet evolved in re- 
ducing infant mortality, correcting prevalent dietary errors, 
improving domestic hygiene, and in generally improving the 
family, social, and economic standards. 

(d) Social service and sick- visiting work by public health 
nurses. The frequent calls of these nurses are a great stimu- 
lant to higher living standc-rds. 



23 

(e) Gradual reformation of the poorly balanced national diet. 

(/) Country-wide installation of Antipolo closets, and potable 
water supplies. Conditions are still far from satisfactory in 
this regard as evidenced by sporadic and endemic outbreak of 
filth and water-borne diseases. 

(g) Extra Cantonment Zone sanitary work in and around 
Camp Claudio. The work done in the zone was instrumental 
in safeguarding the lives of the officers and men of the Phil- 
ippine National Guard Division held in training at Camp Clau- 
dio from dangerous commiinicable diseases, such as cholera, 
typhoid and smallpox. 

C. EPIDEMIOLOGY. 

(a) Cholera has been kept under control, though sporadic 
outbreaks and small-sized epidemics were prevalent. Incessant 
watchfulness and prompt energetic work were constantly re- 
quired. 

(b) Seasonal incidence of dysentery decreasing progressively, 
due largely to improved water supply and sewage facilities. 

(c) Plague not present. 

(d) Smallpox, although widely prevalent and epidemic, has 
been held in control. A total of 3,285,376 vaccinations were 
performed, with 63.22 per cent positives. 

(e) Influenza occurred in two epidemic waves. The first, 
during May, June, and July, characterized by slight mortality ; the 
second, during latter part of September and throughout October, 
November, and December, and attended with high mortality 
percentage through respiratory, cardiac and renal complica- 
tions. All^ known and approved sanitary measures failed to 
check the spread of the disease, which finally died out when 
fresh victims were no longer available. 

(/) Malaria still prevalent, and heading with tuberculosis 
list of diseases causing most deaths. 

(g) Rabies has been controlled. 

(h) Diphtheria has been materially curtailed. 

(i) Routine fly, rat, and mosquito extermination work has 
been kept up in collaboration with the above epidemiological 
efforts. 

D. VARIOUS WORK. 

(a) School inspection has been developed to the utmost lat- 
itude compatible with present appropriation. A total of 1,418 
were inspected and 186,233 pupils examined. Disposal of ex- 
creta in school has been likewise inspected, and where nuisances 
were observed, they were immediately caused to be corrected. 



24 

(6) Confidence of people and cooperation of local practitio- 
ners materially increased, both through results and through 
publicity work. 

(c) Substantial construction work at Culion and San Lazaro 
Hospital and elsewhere carried out. 

(d) Great interest and advancement in sanitary work has 
been noticeable among the non-Christian people. The Pacific 
Coast of Mindanao has been given, for the first time in history, 
the benefits of a health organization. 

V. DE Jesus, 
Acting Director of Health, 
The Honorable, 

The Secretary of Public Instruction, 

Manila, 



REPORT OF THE DIVISIONS OF GENERAL INSPECTION AND 

HOSPITALS. 

[Assistant Director of Health Vicente de Jesus, in charge,] 



DIVISION OF GENERAL INSPECTION. 

COUNCIIi OF HYGIENE. 

The Council of Hygiene held 3 ordinary and 11 extraordinary 
sessions during the year. The work accomplished by the Coun- 
cil was as follows : 

At the regular sessions the following subjects were treated: 
Discussion of the treatment and cure of leprosy as employed 
at the Culion Leper Colony, especially with reference to the 
Mercado treatment, and a comparison of the results obtained. 
Discussion of the cause of the increased mortality in the city 
of Manila and its reduction; namely, (a) by relieving the con- 
gestion of Manila's populace, (6) by extending the city limits 
of the city of Manila, (c) by the urbanization of the suburbs, 
(d) and by the establishment of sanitary barrios for the 
laborers. Discussion of the control and eradication of smallpox 
in the city of Manila and in the provinces. Discussion of the 
revision of the laws and regulations governing the practice of 
optometry. The drafting of laws and regulations governing 
bacteriologists, pathologists, and the equipment of laboratories. 

In the extraordinary sessions the following subjects were 
considered. The proposed amendment of Act 2468 and the 
repeal of Act 2510 were discussed and returned to the author 
of the amendment with an amendment to the amendment and 
recommendation. The Bill creating the Pharmacy Inspection 
Board was reconsidered and returned to the Secretary of Public 
Instruction with a statement of the reasons and motives upon 
which the proposed bill and amendment were based. The ex- 
amination questions for entrance to and promotions of officers 
in the Philippine Health Service were prepared. The out-houses 
for contagious diseases at San Lazaro Hospital were inspected 
with a view to suggesting improvements and, in view of the 
insufficient space for the proper isolation of cases of smallpox 
during the recent smallpox epidemic, to consider the advisability 
of building additional out-houses; also to consider the advis- 
ability of the installation of a laboratory at San Lazaro Hospital 
in order to avoid the delay involved in the present practice of 
sending specimens to the Bureau of Science for examination. 

25 



26 

Consideration and discussion of bottled mineral-medicinal waters. 
The study and revision of laws governing the practice of me- 
dicine, the professions of midwifery and nursing, and the draft- 
ing of laws governing child labor. 

The labors of the Council have been of inestimable value in 
making suggestions, amendments, and recommendations to be 
incorporated into law, and as a guide in matters pertaining to 
the Health Service and its allied branches from a hygienic, 
sanitary, and legal point of view. 

FOOD AND DRUG INSPKCTION. 

The Board of Food and Drug Inspection held semimonthly 
meetings to pass upon questions arising in connection with the 
enforcement of the Food and Drugs Act and to receive protests 
against any action taken in its administration, in so far as this 
Act refers to foods. The Board performed the same function 
with respect to drugs and medicines in connection with the Food 
and Drugs Act and the Proprietary Medicine Act until Feb- 
ruary 28, when by Act No. 2762 control over drugs and me- 
dicines was vested in the Board of Pharmaceutical Examiners 
and Inspectors. 

Of importations of foods of which samples were submitted 
to the Bureau of Science, 87 were admitted without change of 
label, 31 were admitted upon amendment of label, 16 were 
rejected, and 1 shipment of alcohol found to contain methyl 
alcohol was admitted upon denaturing so that it could not be 
used in food products. The reasons for relabeling and for 
rejection were as follows : 

RELABELING. 

Short weight 6 

Lack of English label 6 

Misbranded as to name of product 2 

Net weight not stated or illegible 13 

Kind of preservative in canned sardines not stated 2 

Sweetened condensed milk labeled ''Condensed Milk'^ (1 also short 

weight) 2 

Total 31 

REJECTION. 

Illicium religiosum (importation prohibited) 5 

Contained copper 4 

Canned goods containing an excessive amount of sirup '. 2 

Baking powder, less than 12 per cent available carbon dioxide 1 

Contained excessive amount of sulphuric acid 3 

Contained boric acid 1 

Total 16 



27 

In addition, samples were collected by the food and drug in- 
spector and analyzed by the Bureau of Science as follows : 

Milk 61 

Foods 304 

Drugs 14 

Food colors 2 

Beverages 151 

Total 532 

Also numerous samples from the provinces were submitted by 
the district health officers. 

The following food products were condemned: 

Cheese cans... 4,157 

Sardines do 3,043 

Salmon .....do. 127,536 

Greyfish cases... . 100 

Wheat flour tons.... 3 

Spaghetti cans.... 1,824 

The following administrative decisions under the Food and 
Drugs Act were issued : 

No. 165-a. — Defining and fixing standards for plain chocolate; sweetened 
chocolate; and sweetened chocolate with peanut, first, second, 
and third class. 
No. 172. — Defining and fixing standards for condiments other than vinegars 

and salt. 
No. 173. — Defining and fixing standards for canned vegetables, canned peas, 

and canned pea grades. 
No. 174. — Defining and fixing standard for baking powder. 
No. 174-a. — Defining and fixing standard for carabao's milk. 
No. 174-6. — Defining and fixing standards for hagoong and patis. 
No. 175. — Adding four yellow shades to the list of permitted coal-tar dyes. 
No. 176. — Defining and fixing standard for evaporated apples. 
No. 177. — Defining and fixing standards for soda water flavors and soda, 
soda water. 

Seven proposed trade-marks for food or drug products were 
submitted, of which 3 were found to meet the requirements of 
law and 4 required amendment. These were passed upon by 
the Board in accordance with an agreement entered into in De- 
cember, 1913, with the chief of the division of archives, patents, 
copyrights and trademarks, then a branch of the Executive 
Bureau, as it had occurred on several occasions that labels to 
which copyright had been secured were, when applied to the 
food products for which they were intended, in violation of the 
Food and Drugs Act and their use prohibited. It was therefore 
believed, as a matter of interbureau cooperation both to save 
needless expense for the manufacturer or dealer and to secure 



28 

more efficient enforcement of the Food and Drugs Act, that such 
labels should be passed upon by the Board before the issuance 
of copyrights. However, since the division charged with the 
issuance of copyrights was annexed to the Bureau of Commerce 
and Industry the latter has decided that this practice occasioned 
unnecessary loss of time and has discontinued it. 

Fines were imposed by the court for violations of the Food 
and Drugs Act as follows : 

Chili sauce, colored with a nonpermitted coal-tar dye, short measure, 
packed in bottle with name of another manufacturer blown in the 
glass f=30 

Chocolate, adulterated with peanut 100 

Vinegar, 2.5 per cent acetic acid (standard 4 per cent labeled "3 per 

cent," quantity not stated 20 

Table sauce, contained benzoic acid, quantity of contents of bottle not 
stated 100 

Dog meat sold for goat meat 25 

Total ^275 

Also four fines, totaling ^35, were imposed under the ordinances 
of the city of Manila for selling adulterated or dirty milk. 

Through the efforts of the board and of the food and drug 
inspector all dairies selling milk in Manila have installed pas- 
teurizing apparatus of a cheap but efficient type design by the 
food and drug inspector. All milk coming from dairies is now 
produced and handled in a sanitary manner. Carabao's milk 
sold in Manila and in the provinces is often watered. An effort 
is being made to put and end to this practice. 

The matter of nipa vinegar from Bulacan and Pampanga 
Provinces sold in Manila, deficient in acetic acid, was taken up 
and instructions as to the proper method of production were 
distributed to the various producers. 

provinciaij cemeteries. 

In spite of the heavy campaign work imposed upon the me- 
dical officers of this Service by the frequent outbreak of epi- 
demics in most of the provinces throughout the entire year the 
activity and improvement of the preceding year of this branch 
of the Service continued during the year 1918. Thirty-one ce- 
meteries were reported as being in an insanitary condition, 2 of 
which were closed, the remaining 29 cemeteries undergoing 
repairs and improvements at the end of the year, the work being 
greatly retarded on account of epidemical outbreaks. 

The following table shows the various activities during the 
year 1918 as compared with the previous year: 



29 



1017 lUlS 



New cemeteries approved. 
Old cemeteries approved _- 
Old cemeteries reopened .. 



Total 

Old cemeteries closed . 



Extensions of time grranted 

Enlargements approved 

Proposed now cemeteries disapproved... 
Cemeteries reported as being insanitary. 
Cemeteries reported as being sanitary..- 



75 1 


80 


33 1 


13 


21 1 


25 


129 


118 


45 1 


25 


73 : 


39 


13 1 


6 


7 1 


1 


67! 


31 


98 ! 


50 



DIVISION OF HOSPITALS. 

This division includes the following hospitals: 

INSULAR. 

San Lazaro Hospital, Manila. 

Bilibid Hospital, Manila. 

Baguio Hospital, Mountain Province. 

Bontoc Hospital, Mountain Province. 

Kiangan Hospital, Mountain Province. 

Cuyo Hospital, Palawan. 

Iwahig Penal Colony Hospital, Palawan. 

Bayombong Hospital, Nueva Vizcaya. 

MINDANAO AND SULU. 

Sulu Public Hospital. 
Lanao Public Hospital. 
Cotabato Public Hospital. 
Zamboanga Public Hospital. 
Rizal Memorial Hospital. 
Butuan Hospital. 

PROVINCIAL. 

Albay, Albay. 

Naga, Ambos Camarines. 

Tacloban, Leyte. 

BAGUIO HOSPITAL. 

The work accomplished during the year may be summarized 
as follows: 

There were cases of trancazo during the month of November 
and the early part of December, and as the hospital could not 
provide sufficient accomodations for all the patients, the Bureau 
of Public Works and the city of Baguio had to provide provisional 
hospitals for their laborers; also the agricultural school at La 
Trinidad had to utilize one of its buildings as a temporary hos- 
pital for its students, mostly Igorots. Ninety per cent of the 
cases treated in and outside of the hospital recovered, the deaths 
being largely due to complications. 



30 

The hospital personnel has been very efficient and the results 
of the year's work have been very satisfactory in every respect. 

The prices of goods purchased for the hospital were almost 
double those of the previous year and the expenses could not be 
kept below 95 centavos daily per capita. 

General repairs are being made to the main hospital build- 
ing, and a new cottage for contagious cases is planned to 
replace the present tents. 

Much of the furniture in the hospital is unserviceable and 
should be replaced. 

MISCELLANEOUS SUMMARY. 

Patients remaining over from previous year 16 

Patients admitted during the year 856 

Hospital cases treated during the year 872 

Patients remaining in hospital December 31st 18 

Persons accompanying patients in hospital 134 

Patients who visited the hospital clinic 8,019 

Patients who attended the hospital clinic 5,003 

Surgical dressings 2,915 

Prescriptions filled 5,124 

Laboratory examinations made 333 

Major operations performed 11 

Minor operations performed 222 

Prostitutes examined 41 

Chauffeurs examined 35 

Officers and enlisted men of National Guard examined 100 

Americans treated in hospital 51 

Filipinos treated in hospital 739 

Europeans treated in hospital 35 

Japanese treated in hospital 12 

Chinese treated in hospital 19 

Male patients treated in hospital 560 

Female patients treated in hospital 312 

Deaths in hospital during the year 44 

BAYOMBONG HOSPITAL. 

While the building in which this hospital is housed is in- 
adequate for a hospital, nevertheless the hospital has been a very 
great blessing and comfort to those who came in for treatment. 
Dring the year 1918, 228 patients were admitted with 8 deaths. 
Of this number one was a Japanese, one a German, and the 
remainder were Filipinos, comprised of Christians and noA- 
Christians. 

ADMISSION OF PATIENTS. 

Remaining in hospital January 1, 1918 6 

Admitted 228 

234 

Died. 8 

Discharged 226 

234 



31 

PERSONNEL. 

1 chief (D. H. O.). 

2 nurses. 
1 servant. 

SUBSISTENCE. 

Total subsistence expended ^90.00 

Cost of subsistence per person per day 0.30 

RECOMMENDATION BY THE MEDICAL OFFICER IN CHARGE. 

That a new concrete hospital building be constructed, the 
present building not only being inadequate for a hospital, but 
is also unsuitable for such purpose as it is a light material 
structure. 

BILIBID HOSPITAL. 

Bilibid Prison, in Manila, occupies a space of 34,224 square 
meters of land. It is divided into two distinct departments, 
the Presidio and the Carcel departments. The presidio depart- 
ment comprises six sleeping brigades, the various shops of the 
industrial division and two presidio ''cell houses." The carcel 
department comprises seven sleeping brigades and two carcel 
''cell houses.'' 

The' hospital is located at the extreme north of the presidio 
and carcel departments separated from them by a wall with a 
gate leading to the presidio side. It occupies a space of slightly 
over a hectare of land. It is a three-story, well ventilated, con- 
crete building with a capacity of about 400 beds. It has four 
spacious wards, three isolating wards on the roof for male pa- 
tients, a fair-sized women's ward, an operating room with its 
sterilizing apartment, a dressing room for emergency and in- 
fected cases, a clinical laboratory, a morgue, a dispensary, a 
doctor's office, chief nurse's office, and attendants' sleeping quar- 
ters, etc., and is furnished with all the conveniences of a good 
modern hospital. On the left side of the hospital the kitchen 
is situated, and on the extreme right are located the quarantine 
department, where incoming prisoners are confined for 12 to 
15 days before their assignment to their respective work in 
prison, and a contagious department where prisoners affected 
with contagious diseases are confined. 

BRIGADES. 

There are in the whole prison 13 concrete buildings used 
for sleeping quarters of prisoners, which are called brigades. 
Each brigade has a capacity varying from 1,500 to 3,100 cubic 
meters, has 32 windows measuring approximately 4 square me- 
ters each, and is provided with 6 toilets, 2 shower baths, and 



32 

a sufficient number of iron beds to accommodate the prisoners, 
whose average number is 200 in each brigade. 

WATER SUPPLY. 

The prison is supplied with the city water, but before this 
water is used for drinking purposes, it is distilled in the prison 
distilling plant and stored in a wooden tank of about 8,000 
gallons capacity, and prisoners are strictly prohibited from 
drinking undistilled water. A supply of distilled water is stored 
in big barrels provided with faucet and cover and placed in 
every brigade. The industrial division, offices, hospital, and 
other departments are also supplied with the distilled water. 

PERSONNEL. 

1 Chief, Philippine Health Service. 

1 resident physician, Philippine Health Service. 

1 chief nurse. Bureau of Prisons. 

1 pharmacist. Bureau of Prisons. 

1 surgical nurse. Bureau of Prisons. 

1 hospital attendant and sanitary inspector. Bureau of Prisons. 

3 practicantes. Bureau of Prisons. 

Prisoner assistants, Bureau of Prisons. 

MORTALITY. 

The general death rate for the year was 21.10 per 1,000, 
figured on an average prisoner population of 6,926; of which 
10.40 per 1,000 represent the deaths due to non-tubercular 
causes, and 10.70 per 1,000 those due to pulmonary tuberculosis. 
Of the total 146 deaths during the year, 8 were Chinese, 137 
Filipinos and 1 American. 

Almost all of the inmates had Spanish influenza, and of those 
who contracted complications in their respiratory organs, nearly 
one-half died. At the date of the outbreak of the first epidemic 
the hospital was so overcrowded that the treatment of 1,897 
patients unable to be admitted was given in their respective 
brigades. Among the 2,674 cases of this disease treated during 
the year, 71 cases of lobar pneumonia complications occurred, 
with 31 deaths. It will be noted that due to influenza and pul- 
monary tuberculosis, the death rate for the year 1918 was 
higher than that of 1917. 

The deaths among the prisoners outside of Bilibid during the 
year were as follows : 

Corregidor: 

General diseases 67 

Pulmonary tuberculosis 45 

Total 112 



33 

Iwahig Penal Colony: 

General diseases 47 

Pulmonary tuberculosis 10 

Total 57 

San Ramon Penal Farm: 

General diseases 8 

Pulmonary tuberculosis 2 

Total 10 

San Lazaro Hospital: 

General diseases 14 

Pulmonary tuberculosis 2 

Total 16 

BIRTHS. 

Eleven births, 8 males and 3 females, occurred in the prison 
during the year, including one case of twins (boys). 

MORBIDITY. 

The chief causes of sickness among the prisoners during the 
year were intestinal parasites, amoebiasis, tuberculosis, venereal 
disease among the new arrivals, contagious eye diseases, conta- 
gious skin diseases, grippe and respiratory diseases. All these 
with the exception of the influenza epidemic and a few other 
cases remaining from last year, were brought into the prison 
by newcomers or prisoners returning from work in the prov- 
inces. 

INTESTINAL PARASITES. 

All prisoners, without exception, upon entering Bilibid Prison, 
after having been given the necessary disinfecting bath and 
change of clothing at the main building under the supervision 
of the sanitary inspector, are vaccinated and then immediately 
sent to the quarantine department where they remain under 
observation for at least 12 to 15 days, and the period may be 
made longer according to the case, before being allowed to mingle 
with other prisoners. While in the quarantine department, the 
blood of each prisoner is examined for filaria, the stool for in- 
testinal parasites and amoeba, and a culture is taken and sent to 
the Bureau of Science for examination for cholera vibrio, to- 
gether with samples of urine for gonococcus, and sputum for 
tubercle bacillus. If the laboratory examination or the clinical 
examination shows that the prisoner is suffering from disease 
or is positive for any of the examinations above mentioned, he is 
transferred to the hospital or to the contagious department as the 
case may be, for treatment. 

168426 3 



34 

A total of 16,476 stool examinations, or 45 daily, were made 
by the laboratory during the year. Of this number, 4,634 were 
found positive for intestinal parasites distributed as follows : 

Ascaris lumbricoides 2,409 

Hookworm 1,636 

Amoeba coli 558 

Amoeba histolytica 21 

Taenia 10 

FILARIA. 

During the year, 2,303 specimens of blood were examined for 
filariasis, both diurnal and nocturnal, 39, or 1.69 per cent, of 
which were found positive. 

VENEREAL DISEASES. 

Gonococcus, — Forty-three gonorrhoeal examinations were made 
during the year, of which 34, or 79 per cent, resulted positive. 
Gonorrhoeal prisoner patients are isolated in a ward in the 
contagious shed, where they remain for treatment until their 
urine gives a negative result on a microscopical examination. 
No gonorrhoea ophthalmia occurred during the year. 

Syphilis. — The number of cases treated during the year was 
52, 49 of which were discharged from the hospital and 3 re- 
mained at the end of the year. Blood specimens were sent 
to the Bureau of Science for Wasserman's reaction to verify 
the diagnosis. 

CHOLERA. 

Bilibid Prison was free from cholera during the entire year. 
Out of the 91,999 cultures taken and sent to the Bureau of 
Science for examination only one man was found to be a positive 
cholera carrier; this was in the month of February. This is 
due to the fact that there was no infection brought into the 
prison and to the rigid precautions exercised by the officials 
and the strictly hygienic way in which prisoners are fed. They 
are required to wash their hands before eating, and their mess 
pans are disinfected the very minute and each time they receive 
their ration. They are each furnished with a spoon and are 
strictly prohibited from eating with their hands. 

LEPROSY. 

Three cases of leprosy were found and transferred to San 
Lazaro Hospital during the year. Their dates of admission to 
the prison were : August 28, 1916 ; January 19, 1918 ; and April 
15, 1915. 



35 

EYE DISEASES. 

Two hundred cases were treated. All of these cases were 
immediately isolated and kept so until cured, to prevent any 
possible contamination. Almost all of the cases of eye diseases 
w^ere contracted by the prisoners working outside of the prison 
reservation or in the provinces. The treatment in nearly all 
cases resulted in a cure. 

SKIN DISEASES. 

There were 344 cases treated in the hospital during the year, 
besides the many milder cases in the out-patient department. 
The majority of those treated were: tinia imbricata, scabies 
and eczema. 

Treatment of the milder cases unable to come to the hospital 
was given three times a w^eek in their corresponding brigades 
by prisoners classed as hospital servants. 

RESPIRATORY DISEASES. 

The increased death rate from these diseases was due to the 
influenza epidemic as already mentioned. 

Ninety-four cases of lobar pneumonia were treated, with 36 
deaths; also 29 cases of asthma and 1 case of gangrene of the 
lungs. 

BERIBERI. 

Twelve cases of beriberi were treated during the year. Most 
of these cases were brought to Bilibid Prison by the newcomers 
and prisoners working outside and in the provinces. The use 
of unpolished instead of polished rice has greatly diminished 
the cases of this disease in Bilibid Prison during the past few 
years. 

TUBERCULOSIS. 

Pulmonary tuberculosis as in previous years continues to hold 
the first place in regard to morbidity and mortality among the 
prisoners. Of the 179 cases treated during the year, 108 or 
65.95 per cent died. The transference of tuberculous prisoners 
to Iwahig Penal Colony or elsewhere would improve the health 
of the prisoners transferred and prevent infection inside Bilibid 
Prison. 

OTHER CONTAGIOUS DISEASES. 

The following cases were treated during the year: 

Measles 17 

Mumps 138 

Varicella 18 

Varioloid —- 2 

Smallpox 3 



36 : 

1 

No deaths occurred on account of these diseases during the I 
year. ] 

GENERAL MEDICAL SURVEY. 

In the annual general medical survey of the prison 2,633 pris- 
oners, including females, were examined physically and micro- 
scopically, and 39.08 per cent were found positive for intestinal 
parasites. 

The general results of the examination was as follows: 

Skin diseases 876 

Eye diseases 147 

Mouth and teeth diseases 384 

Hemorrhoids 59 | 

Hydrocele 19 | 

Hernia 15 ^ 

Fistula in anus 5 

Lipoma -. 32 : 

Varicocele .-- 19 i 

Varicose veins 16 

Cataract 3 

Male congenital malformations — phimosis 4 

Male congenital malformations — harelip 1 

RECOMMENDATIONS. 

1. That more windows in both the presidio and carcel ''cell 
houses" be opened to admit more light and air. 

2. That a morgue be built separated from the hospital proper. 

3. That another hospital for tubercular patients be constructed 
in lieu of the one ward at present used, so as to prevent con- 
tamination among the inmates; otherwise tuberculous patients 
should be sent to Iwahig tuberculosis colony. 

4. That women prisoners be not allowed to bring their children 
with them, and that deliveries take place outside the prison. 

5. That one clerk be permanently detailed to the office of the 
doctor to keep all records therein. 

6. That one dentist be provided. 

BONTOC HOSPITAL. 

A new schedule of charges was submitted and approved by 
the proper head of Department. In general, the hospital was 
conducted under the regular hospital rules, and special rules 
or modifications have been promulgated to meet the necessary 
local conditions, through biweekly bulletins. In these bulletins 
appear changes, assignments, disciplinary measures among the 
personnel, and they serve as personal talks. 

One private room near the main entrance of the hospital has 
been made available for delivery and examining room. 



37 

Hospital Apartments. 

1. Private r 007ns: 

2 rooms of 1 bed capacity each. 
2 rooms of 2 beds capacity each. 
1 room of 2 beds capacity (low payment). 

2. Free ward: 

Male apartment, 20 beds capacity. 
Female apartment, 10 beds capacity. 
o. Isolation apartment: 

Male, no specified limit ^i^^dequate. 
Female, no specified limit j 

For complete isolation of lepers, a small cottage is situated 
a short distance from the hospital proper. There is imperative 
need of enlarging the hospital. The present arrangement of 
different apartments is very defective for the kitchen is too close 
to the private rooms, and during cooking the odors of the foods 
penetrate all the private rooms and the operating room and the 
office of the chief and superintendent. Another defect is that 
the noise caused by w^ashing plates and kitchen utensils is very 
annoying to the pay patients. Another building is badly needed 
for kitchen and dining room of the hospital staff. 

There is also need of another building for the accommodation 
of patients. Patients v^ith contagious diseases have no adequate 
places because the present apartment for them, v^hich is in the 
service building, is too small. Besides, in the service building, 
there are a commissary apartment, general supplies apartment, 
drug room, laboratory, hospital laundry, room for petroleum and 
muchachos, quarters, and no adequate accommodations remain 
for contagious diseases. 

PERSONNEL. 

1 Chief of the hospital. 

1 resident physician. 

1 superintendent and cashier. 

5 nurses. 

1 cook 

2 laundrymen. 
8 house boys. 

CHANGES IN THE PERSONNEL. 

The position of resident physician v^as vacant except for 
about two months during the year. Consequently, the chief of 
the hospital has been acting in the capacity of resident physi- 
cian, together with his duties as district health officer. 

In the early days of 1918, the superintendent and cashier was 
transferred and a new one was appointed in his place. 

Since the beginning of the year, there were constant changes 



38 

among the nurses and by the close of the year there were but 
three nurses available in the hospital. 

There were but few changes among the unclassified employees. 

ADMINISTRATIVE DIVISIONS. 

1. General administration (main office). 

2. Nursing department. 

3. Property, commissary and finance. 

4. Pharmacy and drug room. 

5. Unclassified labor service. 

(1) The general administration or office work is performed 
by the chief, the superintendent and the clerk of the district 
health ofl^cer. 

(2) The nursing department includes care of patients, ward 
administration, housekeeping, subsistence, and other duties per- 
taining to nurses' work. As there was no regularly appointed 
chief nurse, arrangement was made that every nurse should 
have a term of three months as acting chief nurse. 

On account of a shortage of nurses the place of acting chief 
nurse was often vacant. During the grippe epidemic which 
swept this place twice during the year, the available nurses 
were all employed in taking care of the sick. In short, there 
was a lack of nurses the whole year round. This was due to 
the constant changes among the nurses, resignations and trans- 
fers. On this account, nurses had to be denied their vacation 
leave, except one who was granted a half -month vacation. 

(3) Property and commissary are under the charge of the 
superintendent, together with the financial and other records of 
the hospital. The stocks during the year were in good condition 
and suflficient supplies were on hand according to estimates. 
But the hospital suffered when the transportation was delayed 
considerably at times during the year due to typhoons which 
damaged the roads, and the supplies did not come at the expected 
time. Thus purchases had to be made in the local market, 
thereby causing a marked increase in hospital expense. 

(4) The pharmacy and drug room are under the charge of 
the chief of the hospital. One sanitary inspector with sufficient 
experience was detailed for routine stock preparations. 



Prescriptions filled ' 7,069 

Average per month - 589 

Average per day 20 



101 



5,626 

468 

16 



191S 



6, 002 

500 

17 



* (5) The unclassified labor service was under the joint super- 
vision of the chief and the superintendent. This service includes 
cook, laundry helpers, house boys, and their miscellaneous duties. 



39 

SERVICES. 

1. In-patient department. 

2. Out-patient department. 

3. Gardening service. 

4. Plumbing service. 

5. Illumination service. 

6. Manufacturing and mending service. 

7. Sanitation service. 

8. General supplies. 

(1) In-patient department. — There were 710 patients ad- 
mitted during 1918, 610 during 1917 and 562 during 1916. 
There were 20 deaths during 1918, 22 during 1917 and 17 during 
1916. 

Patients on hand January 1 33 

Admitted during the year 710 

743 

Discharged during the year 695 

Died during the year 20 

715 

Patients on hand December 31 28 

Major operations 8 

Minor operations 122 

Laboratory examinations 149 

Average hospital days per patient 13.22 

The grippe epidemic which occurred twice during the year 
caused a marked increase of patients. The mortality in the 
second epidemic was 3.4 per cent. There were but two deaths 
in th6 first epidemic, when 72 patients were admitted. The 
average number of hospital days of grippe cases was four. 

One difficulty encountered in treating Igorot patients was that 
practically all of them were loath to submit to liquid or soft diet. 
They submitted to any kind of medical treatment prescribed. 

(2) Out-patient department or dispensary. — The out-patient 
department or dispensary comprises those coming to the hospital 
for medicines, dressings, treatments, etc. 





1916 


1917 


1918 


Cases ,. .- _ . 


2,068 
5,395 


3,115 
10, 544 


3,042 


Treatments ._ __. 


9,797 







(3) Gardening service, — Gardening was carried on during 
most of the year. As there were no regular gardeners to carry 
on the work, the house boys were made to do gardening, usually 
in the afternoons, together with the patients suffering from skin 
diseases. The hard stony soil rendered successful gardening dif- 
ficult, especially in the absence of rain. However, quick-growing 



40 

vegetables were planted and good results were obtained. During 
the grippe epidemic gardening was practically abandoned as 
there was no available personnel. 

(4) Plumbing service. — Plumbing service was not satisfac- 
tory during the year. There have been constant repairs of 
practically the whole plumbing system of the hospital. In many 
instances it greatly inconvenienced the service in general. 
Waste water overflowed in the operating and sterilizing rooms 
and faucets leaked in various places. 

The need of more toilet facilities is imperative. At present 
there is only one water closet for the ward which is used by 
male patients, female patients and children. This water closet 
is situated in a small room, which is at the same time a bath 
room and sink for excreta and waste water and is also used 
for storing urinals, bed pans and sputum sups. • This place 
has had a bad odor the whole year round in spite of efforts to 
keep it sanitary. No change could be made in the arrangement 
because there is no other place available. 

The other water closet is on the first floor of the service 
building which is being used by the patients suffering from skin 
diseases, measles, varicella, etc. 

(5) IllumiTiation service. — The illumination of the hospital 
was chiefly petroleum, which is not satisfactory. In the latter 
part of the year, Clara lamps (alcohol) were used in the main 
hall, porch and sideways. 

(6) Manufacturing and mending service. — During the year 
there was no regular mending service as the personnel was too 
limited. At times mending was performed by the nurses when- 
ever convenient. The only articles manufactured during the | 
year were some table napkins, baby diapers and table cloths. j 
On account of shortage of personnel, no further articles could I 
be manufactured nor could much mending be done. At times | 
female convalescents mended some linen. 

(7) Sanitation service. — The sanitary condition of the hospital 
was maintained during the year. The routine work in regard 

to cleaning was kept up and no alterations were made. The \ 
lack of toilet facilities, as already pointed out, caused much in- | 
convenience on the part of the patients as well as of the per- 
sonnel, especially when there were many patients 

The hospital site, generally speaking, is always sanitary due 
to its natural location and surroundings. It is always free from 
stagnant water. Its only undesirable feature from the sanitary 
point of view is the presence of Igorot rice fields just back of the 
service building. During rice planting this place is always 
flooded by the Igorots and naturally the water leaks down toward 



41 

the building, though it does not bother very much due to a canal 
between the rice fields and the service building. To avoid this 
feature it would be desirable if a portion of this land were ac- 
quired by the hospital. 

SUBSISTENCE. 

^P?" i ~ r 11. I Cost 

! ^9"e^- I per 

y.^.- j .....o«x,. : tions. , J. ita. 
chases. 



A/r^^fU . market I Com- ! Collec- ; „^^ 

^«"t^- pur- missary. i tions. ' P^^ 



January ; P349.00 ' P230. 36 ! P64.75 ' P0.47 

February i 142.56 ; 310.02 i 145.97 ' .42 

March ' 207.60' 506.37 1 36. 91 ! .52 

April ; 166.74 : 298.57 , 49.96 ' .47 

May I 219.55' 347.55 : 75.^3 i .55 

June : 282.66: 385.11 153.54 .66 

July \ 223.78; 344.59 151.92^ .40 

August ' 402.13 344.89 325.^2 .52 

September I 367.45 341.36 161.63 .51 

October 170.93 : 404.29 54.97 .51 

November I 168.39 480.36 38.95 .477 

December i 335.85 489.23 366.44 .495 

...____ ' _ ' ■ 

RECOMMENDATIONS. 

1. The extension of the hospital to provide more accommoda- 
tions for patients and to have a kitchen (new building) away 
from the present private rooms. 

2. The provision of more toilet facilities. 

3. The acquisition of the Igorot rice fields just back of the 
service building. 

CULION LEPER COLONY. 

CONSTRUCTION. 

COLONY PROPER. 

The Protestant chapel, projected several years ago, with funds 
from an outside donation, was started in September, completed 
and dedicated during the Christmas holidays. This edifice fills 
a long-felt want among the leper Protestants who, for a number 
of years, have held their religious services in a nipa shack on 
the water-front. The building, which is of a modified ''model 
house'' style of architecture, is centrally located, being on the 
third level of the colony just above "Worcester Plaza.'' The 
floor plan consists of one large assembly room with pulpit and 
a square partitioned off for use of nonleprous visitors and a 
small anteroom for the pastor. The assemblyroom can seat 
about a hundred. 

The Culion leper clubhouse, which was started last year with 
donations from the lepers and the nonleper employees, was com- 
pleted and inagurated in March. This building is of the "model 
house" type and has been of no small consequence in adding 
to the contentment of the colonists. The floor plan includes a 



42 

large assembly room, a reading room and a library, being sur- 
rounded on all sides by a three-meter veranda. Well attended 
biweekly dances are given, also frequent afternoon teas and 
entertainments. A pool table has been acquired. 

The leper schoolhouse to replace the one condemned and 
torn down some time ago, was started in March and is nearly 
completed. This building too is of the "model house" plan and 
is composed of two large classrooms to accommodate about 400 
pupils separated by a storeroom and a room for the principal. 

The new Imhof septic tank which was started last year is 
now more than two-thirds finished and will be completed in 
about a month after the arrival of materials which have been 
ordered. 

Construction in the sanitary barrio has continued so that the 
barrio now has straight streets and the houses are constructed 
along uniform lines, giving the whole a very pleasing appear- 
ance. The barrio is a very popular portion of the colony, being 
built in a valley which protects it from both the strong north- 
east monsoon and the storms of the rainy season which come 
from the west and south. A combination water closet and 
laundry shed has been constructed in the barrio. Considerable 
swamp land has been reclaimed by filling, giving room for ad- 
ditional growth of the barrio. 

Medicated bath house. — For a number of years it has been 
the desire of this Service to introduce hot medicated baths 
for the lepers, not only to encourage cleanliness but to alleviate 
the suffering caused by the numerous skin diseases, notably 
scabies, so common among lepers in the tropics. The scarcity 
of fresh water and the lack of facilities to heat large quantities 
of water discouraged the project until the recent installation of 
the electric plant. 

In November last, a small bath house was started adjoining 
the electric plant, having facilities for six bathers at a time 
in separate cement tubs. The building, which is of the ''model 
house'' plan is three by six meters, having three bath rooms 
at each end of the building separated by a cement reserve water 
tank occupying the middle third of the floor plan. Into the 
reserve water tank, salt water is pumped from the sea, being 
piped from a depth of about 20 feet, at a point beyond the coral 
reef on the dock side, thus insuring clean water. The water 
from the tank is then run into the inidividual tubs which are 
of sufficient size to allow the patient to submerge to his neck. 
The water in the tanks is heated to the desired temperature 



43 

by live steam from the electric plant and subsequently sodium 
bicarbonate and sulphur are added when prescribed by the phy- 
sicians for special cases. 

The baths are in charge of a leper attendant whose main duty 
is to regulate the temperature of the baths and the time during 
which the bather is submerged. 

Electric light plant, — Due to the failure of the Government 
to provide electric lights after years of planning, the Culion 
Fish and Ice Company incorporated itself as the Culion Ice, 
Fish and Electric Company and installed an electric plant which 
now supplies excellent lights to both the colony and Balala. 

BALALA. 

The Chiefs house, which was started in 1917, was completed 
and occupied in April. This building is also of the modified 
''model house" plan, constructed on the second level, adjoining 
the sisters' house. The floor plan includes a large dining room 
and sala, two bed rooms with baths, a kitchen and a storeroom, 
being surrounded on three sides by a three-meter veranda. 
This house is by far the most attractive building in Culion. 
Unfortunately, the house, which was built during the experi- 
mental period of the "model house,'' was constructed with too 
low a pitch to the roof so that during driving rains there are 
numerous leaks, the water being driven between the tile. 

Clerks' quarters. — The old frame dwelling situated at the top 
of the Balala stairway leading to the second level, having be- 
come unsafe due to the action of white ants and dry rot, was 
torn down and replaced by a double house of the ''model house" 
plan which provides ample accommodations for two families. 

Dock bodega, — For a number of years, there has been felt a 
need for a warehouse on the dock into which steamers could be 
rapidly unloaded, it being necessary, particularly in the rainy 
season, to carry the cargoes directly to the main bodega. There 
being no funds available for such a purpose, a temporary 
structure was erected, composed of first group timbers with 
the galvanized iron roof taken from the clerks' old quarters. 

New launch, — The launch Culion, which has seen continous 
service for nearly ten years, having become unsafe for heavy 
sea duty, it was necessary to construct a new launch. The 
''Bacillus Hansen," a thirty-foot, "V-bottom," all lanete, launch 
was therefore constructed at the colony early in the year and 
fitted with a new 25 horse-power Ferro engine. This launch 
is very seaworthy. 



44 

MAINTENANCE. 

Comparatively little work has been possible along the lines 
of maintenance during the present year due to the uncertainty 
regarding the amount of funds available and the late date at 
which these funds were finally released for expenditure. Such 
repairs as were immediately necessary were made as indicated 
by the circumstances. In the latter part of the year all gal- 
vanized iron roofs were painted. 

The Balala-Colony inclined road which was started last year 
was continued as laborers could be spared from more important 
projects and should be completed in a few months. This road 
leads from the dock bodega to the colony by way of the explosives 
house. It is purposed to install a narrow gauge track and to 
use carabaos and cars to transport the leper supplies from Ba- 
lala instead of the present expensive hand portage. 

Surface drains. — Experience gained in previous rainy seasons 
indicated the necessity for several additional storm water drains. 
The two largest were placed, one leading along the road from 
Worcester Plaza to the canteen and another from tenement 
house No. 1 to the ice plant. 

GENERAL ADMINISTRATION. 

Clay tile and bricks, — Experiments were made in the latter 
part of the year to design a clay tile which could be used to 
replace the present expensive cement tile. Models of tile sim- 
ilar to the slate roofing commonly used in the United States 
were made from special forms and sent to Manila to be burned 
in the kilns at San Pedro Makati. Upon receipt of advice 
regarding the burning of these tile, this division should be in 
a position to make first-class tile and brick since it has clay 
which is said to be better for the purpose than that used in 
Manila. 

Children's house. — During the year, 3 children were returned 
to the colony as lepers and 1 died of bacillary dysentery. Up 
to the present time, 64 babies have been isolated in the house; 
18 have died, 18 were returned to the colony as lepers, 4 were 
returned with contagious diseases and 24 remain in the house. 
The children's house, which was constructed as an experimental 
institution, has shown the inadvisability of leaving the babies 
with their leper parents in the colony after the age of six 
months, as in such case a large percentage will certainly de- 
velop leprosy. 



45 

Negative house, — Five lepers, having been isolated in the ne- 
gative house for two years and during that time not having 
been found to be bacterioscopically lepers, were sent to Manila 
for final examination by the technical committee. Four were 
released provisionally ; one, having developed a spot on his cheek 
which was found to be bacterioscopically positive, was retained 
in San Lazaro. Five additional lepers were placed in the nega- 
tive house for two years' observation. 

Epidemic of influenza. — For the first time in the history of 
the colony, an epidemic disease has reached the colony proper. 
Influenza, in its world infestation, entered the colony in the 
month of October and took a toll of 216 lepers. 

Typhoon. — Christmas night and the following day, for the 
first time since 1910, the colony was visited by a destructive 
typhoon which felled nearly 100 nipa houses but did no damage 
to permanent structures. The rebuilding of the leper houses is 
going on rapidly with materials issued by the Government. 

Holiday visitors. — As has been the custom for several years 
past, the colony received visitors from the provinces during the 
Christmas holidays. This visit gives the parents and friends 
of the lepers an opportunity to see the actual conditions in Culion 
as well as to visit their relatives. This custom has more than 
repaid the Government for the expense, in aiding the collection 
of lepers at large and giving the lie to the former adverse crit- 
icisms regarding conditions in the colony. 

CHAULMOOGRA OIL TREATMENT OF LEPROSY. 

Experiments have been continued as in the past to determine 
whether there is any curative value in the chaulmoogra oil for- 
mula. There is nothing new to report regarding the treatment. 

RESEARCH. 

In July a paper was submitted for publication in the Phillip^ 
pine Journal of Science entitled '*A Photographic Study of Lep- 
rosy.'' The purpose of the paper being to show, by illustrations, 
the progression of the disease in its various types. 

A study of leprosy among children was made by the Chief 
of the colony and the records of the investigation will be pub- 
lished in the near future, probably in the Journal of the Amer- 
ican Medical Association. 

A study of the mortality and morbidity records of the colony 
since its beginning was made and will be published in the near 
future. 



46 



RECOMMENDATIONS. 



(1) The Imhof septic tank should be finished and used as 
soon as practicable. The old tank is badly cracked and in a 
leaky, consequently filthy, condition. 

(2) A new tenement house, of the modified "model house'' 
plan should be constructed upon the site already leveled, just 
below the Catholic church in the colony. Working plans for 
this building are on file. 

(3) Upon completion of the new tenement house, the old 
frame dwelling now situated below the Catholic church and to 
the right of the negative house should be torn down and the 
occupants given the new tenement house. It is imperative that 
this frame building be torn down before another baguio season. 

(4) The construction of a new hospital ward of not less than 
60 beds capacity should be started as soon as practicable, to be 
located adjoining the present hospital annex used for women. 
This building should be of the model house style but should have 
a cement floor with floor drains since it is necessary not only to 
disinfect leper wards but to flush them daily with water. The 
site suggested will give a solid rock foundation and will need 
only enough blasting to give a level foundation. 

(5) Preparations should be made after the completion of the 
new ward to continue the proposed plan for the old hospital, 
namely, to add a second floor to the present old hospital connecting 
it with the second floor of the new hospital, thus adding two new 
wards, each with accommodations for 60 beds, and two or three 
small private rooms for patients. The north side of the portion 
over the present offices and rooms for the staff should be reserved 
for a much-needed laboratory. 

(6) Not less than two additional tenement houses should be 
constructed on the open side of Worcester Plaza just above the 
sanitary barrio. 

(7) At least one and preferably two new toilet-laundry build- 
ings should be placed in the sanitary barrio to accommodate the 
rapidly growing population there. These should be supplied 
with water from the new system recommended in the next 
paragraph. 

(8) A secondary dam should be constructed below the present 
dam in the river valley, to collect the subsoil seepage below the 
present dam. This secondary dam and reservoir should be for 
the exclusive use of the sanitary barrio, quarantine station and 
the portion of the colony proper situated on the water-front 



47 

facing Balala, by this means giving a pressure from the old 
system sufficient to supply the people on the second and third 
levels of the colony proper, who now cannot get water except 
when no one of the sea-level has the faucets open. A large part 
of the expense of this new system can be saved if cement pipes 
are used in place of galvanized pipe for the portion of the line 
not exposed to falling trees during the rainy season. A satis- 
factory cement pipe has been made in the colony, which with 
slight modification will serve the purpose. 

(9) A new toilet and laundry building should be constructed 
at the quarantine station to replace the present midden-shed, 
this should be connected with the proposed water line and will 
not only save considerable labor in carrying fresh water into 
quarantine from the colony above, but will reduce the nuisances 
caused by the old shed. 

(10) A new dwelling for the Filipino clerks, a duplicate of 
the one recently finished, should be constructed so that the clerks 
now living in the chiefs old quarters may be given a safe house, 
the chiefs old quarters having been condemned as unsafe for 
further use. 

(11) A new lighter should be constructed to replace the one 
condemned and destroyed, to transport building materials from 
the lumber camps to the colony. At present the freight boat 
belonging to the Culion Ice, Fish and Electric Company is being 
used, to their inconvenience, since the boat is needed by them to 
haul firewood for their plant. 

(12) A new blacksmith and machine shop should be con- 
structed to replace the present one in Balala, which is now ac- 
tually tumbling down. This can be done at small expense with 
a few barrels of cement for footings and a few harrigues, using 
the present iron roof. 

Subsistence. 



Month. 


Employees' 
mess. 


Filipino 

mess. 


Leper 

mess. 


Laborers' 
mess. 


January 


PI, 100. 19 
981. 96 
1. 054. 00 
1, 020. 90 
1, 023. 00 
1,027.05 

1. 085. 00 
965. 34 
972. 00 

1,209.00 
1. 108. 20 

1. 107. 01 


P21 1.575 
220. 08 
251. 10 
297. 00 
231. 725 
179. 55 
160.425 
203. 67 
191.40 
178. 56 
165.00 
164. 92 


P26.726.061 
24, 187. 80 
27, 249. 434 
28,214.22 
29, 304. 734 
29, 053. 08 
31,398.381 
33, 486. 572 
38, 312. 70 
36,721.67 
35, 643. 90 
31.727.26 


PI, 625. 64 


Pebuary 

March 

April 

May 


1.577.66 
1, 910. 592 
1, 896. 60 
1, 938. 74 


June _ . ._ _ . . 


1, 958. 10 


July.. 


1, 368. 96 


August - ._. - . -.- - 


1, 194. 12 


September. _ - 


1, 482. 90 


October 


1, 825. 28 


November 


1, 639. 53 


December- - .. 


1. 300. 48 






Total , 


12, 653. 65 


2. 455. 00 


372, 025. 81 


19, 719. 60 







48 

AVERAGE COST PER PERSON PER DAY. 

Employees* mess f*=1.72 

Filipino mess 0.69625 

Leper mess 0.214525 

Laborers' mess 0.34186 

PAYROLLS. 

Emergency f»=7,503.60 

General 18,605.10 

Construction 13,495.50 

Leper employees 8,795.24 

Leper payroll, public works 9,866.82 

Leper payroll, maintenance 1,257.25 

Leper payroll, chapel -- 741.80 

Gratuities to lepers 37,428.08 

CUYO HOSPITAL. 

This hospital is conducted in a building rented by the Govern- 
ment from the Parish Priest of Cuyo. This building is in- 
adequate for a hospital, but until the proposed new hospital 
for Cuyo is constructed, there is nothing better available. 

ADMISSION AND DISCHARGE OF PATIENTS. 

There were in all 138 patients admitted into the hospital during 
the year; 2 patients remained over from last year, making a 
total of 140 patients treated during the year. Of this total 119 
were discharged from the hospital as cured, 17 discharged as 
improved, 2 died, and 2 remained in the hospital at the end of 
the year. 

The most important diseases treated were; Malaria, 23; in- 
testinal parasites, 20; and diseases of the stomach, 17. While 
the number of malarial cases treated is compartively high, in 
reality this is a non-malarial district, the cases admitted into 
the hospital having come from Mindoro and Palawan. 

PERSONNEL. 

Dr. E. Ochoa was chief of the hospital from January to Sep- 
tember and Dr. P. Araujo from October 21 to the end of the 
year. Mrs. Ochoa was employed as nurse from the beginning 
of the year to August. The personnel of the hospital at the 
end of the period of the year 1918 was composed of one chief, 
one dispensary helper, one clerk, one cook and two servants. 

DISPENSAKY. 

During the year there were 4,193 dispensary patients treated 
in the hospital, 2,094 dressings made, 164 minor operations per- 
formed, and 1,837 prescriptions filled. The total shows an in- 
crease over last year. 



49 



MUNICIPAL SANITATION. 



The chief of the Cuyo hospital also acted as local health officer 
for the municipality of Cuyo. Smallpox vaccination was carried 
out to some extent but has not been thorough on account of lack 
of personnel and funds to carry it out more extensively. In the 
month of November there was an epidemic of grippe and an 
estimated calculation showed that about 90.85 per cent of the 
population of the island of Cuyo had been attacked. In the mu- 
nicipality of Cuyo only one sanitary inspector attended to all 
the work of disinfecting and vaccinating, besides his regular 
duties. 

SUBSISTENCE. 

Balance on hand from 1917 ^503.22 

Purchased from Bureau of Supply 405.96 

Purchased in open market 622.77 

Total : 1,531.95 

Total subsistence consumed during the year 1,247.52 

Total subsistence condemned 94.05 

Total subsistence missing 106.38 

Total subsistence remaining in the hospital, January 1, 1919 84.00 

Total 1,531.95 

INCOME. 

The total collection of the hospital during the year was 
?=265.83. 

During the year the voluntary contribution fund for the con- 
struction of a proposed new hospital for Cuyo has been raised 
from ^1,635 at the close of the year 1917 to a total of tM,939.97 ; 
so that the construction of the proposed new hospital is drawing 
nearer each year. 

IWAHIG PENAL COLONY. 

The average population of the colony during the year was 
1,000, including colonists, employees and their families. All 
the able-bodied men were engaged in industrial and agricultural 
work directed by the employees and under the supervision of 
the superintendent. The site, which has an area of 16 hectares, 
is supplied by springs which furnish sufficient water of good 
quality for drinking and other purposes, principally the irri- 
gation of the plantations of rice and other food plants. 

For the treatment of the sick, there is a general hospital of 
mixed materials with two rooms for 50 beds, a small room of 
2 beds for communicable diseases, an operating room, a treat- 
ment room, a laboratory, a dispensary, an office, a nurses' room, 

168426 4 



50 

a bath room, kitchen, a toilet and a morgue. Also a camarin 
of mixed materials with cement floor, with a capacity for 12 
beds, a kitchen, toilet and bath, and a small morgue is now used 
for advanced cases of pulmonary tuberculosis. A hospital for 
women and children has been moved to about 2 kilometers from 
the general hospital. It is of strong materials with galvanized 
iron roof but with partitions of woven bamboo and has a ca- 
pacity for 10 beds, a kitchen and a small nurses' room. The 
hospital servants are colonists, some of whom have served in 
Bilibid Hospital. Their number has been reduced from 37 to 26. 

In addition to the hospital for advanced cases of tu- 
berculosis, there is a sort of sanatorium at the stations of Ka- 
magong and Malinao for less advanced cases and those which 
have improved in the hospital. These sites are about 3 meters 
above sea-level. The buildings are of wood thatched with nipa, 
and it is proposed to move them to another site more elevated 
and farther from the seashore. 

With the progress of improvements on the reservation it is 
hoped that its sanitary conditions will likewise improve, with 
a resultant decrease in mortality from malaria which is quite 
prevalent now due to the abundance of vegetation and continuous 
cultivation of the soil, also faulty drainage and irrigation canals 
and the unevenness of the ground which gives rise to pools of 
water during the rainy season, favoring the breeding of mos- 
quitoes. It has been observed that cases are most frequently 
registered among the persons who work in the fields and live 
in low sites. 

All the colonists sleep in groups in wooden houses with nipa 
roofs in the form of camarins constructed in the stations, some 
of them being provided with a bamboo or wooden bed, while 
others sleep upon the wooden or bamboo floor, each having a 
petate, a mosquito net, a sheet, a tin basin which serves as a 
plate and drinking cup, and two or three changes of clothing; 
except that those who are employed in agriculture and live 
with their own families have their respective houses and re- 
ceive family rations and an open credit for such articles as 
they require with the privilege of paying for them with the 
products of their labor. 

The daily per capita cost of subsistence is only 20 centavos, 
which is very small, especially taking into account the high 
prices of some of the most necessary articles, such as rice, so 
that often breakfast consists of only a little coffee or tea, sweet 
potato or com meal with a little sugar; and dinner and supper 



51 

consist of rice alone or mixed with corn, and a small piece of 
fish cooked in water, with a small amount of legumes or vege- 
tables; twice a week a little meat being served instead of fish. 
This ration is insufficient and in consequence the colonists con- 
tract diseases before becoming acclimated, principally malaria. 
The colonists who are employed in the domestic service of the 
employees, and the foremen receive a small monthly allowance 
so that they are better fed. 

The water supply system consists of pipes leading the water 
to the houses from a tank installed at a point higher than the 
spring. The water is of good quality* and is usually boiled be- 
fore being used. Nevertheless, there appear from time to time 
isolated cases of dysentery and intestinal parasites, which is 
believed to be due to the fact that some laborers in the fields 
and on the roads drink water from. any convenient source. To 
the stations not reached by the pipes, water is carried in tin 
buckets by means of bancas. The extension of the pipes to 
these sites is contemplated. 

The garbage system consists of petroleum cans, fitted with 
covers, which are collected daily in carts, and the garbage is 
used as fertilizer. Formerly it was deposited on the surface, 
but to avoid its forming a breeding place for flies its burial or 
cremation whenever possible has been recommended. 

Some of the employees' houses have odorless toilets; others, 
the hospitals and the schoolhouse use fly-proof buckets which 
are gathered and cleaned daily. The stations and th^ agri- 
culturists' houses use the Antipolo system The stations along 
the seashore use toilets discharging directly into the water. 

In the new central there is a general odorless drainage system 
installed from the houses including the public toilet into a 
cement canal provided with a tank and outlet canal to the river, 
whose water is not used. Some of the houses have cement 
canals ; nearly all, including the hospitals and roads, have canals 
of earth or boulders, the latter being abundant in the colony, 
which are repaired and cleaned from time to time. 

There is a cemetery more than 50 meters square for the ex- 
clusive use of the colony, situated more than one and a half 
meters above sea level, inclosed with barbed wire, having 
straight paths and cross paths one and one-half meters wide 
and planted with trees and containing a chapel where the reli- 
gious rites are held. The graves are symmetrically laid out 
and uniformly marked with a wooden cross. The 25-meter 
zone surrounding the cemetery is unoccupied. 



52 

A slaughterhouse has recently been constructed on the bank 
of a river. It is of wood with nipa roof and cement floor. 
From the slaughterhouse the beef and mutton are transported 
to the refrigerating room, from which they are delivered to the 
consumers. 

The most prevalent disease is malaria in its various forms, 
the most frequent being splenic and cachectic, which on autopsy 
shows a voluminous infarct of the base weighing about 3 kilo- 
grams. All the inhabitants of the colony, including the chil- 
dren, have been attacked by the disease in a more or less benign 
form. The pernicious form of the disease is observed from 
May to September, when cases of black-water fever or malaria 
haematuria are registered, the patients having abundant and 
blood-scented urine. It does not appear that the intense heat 
and change of temperature at this period exercise a notable in- 
fluence in the development of the disease. 

The cases of pulmonary tuberculosis are increased from time 
to time by new arrivals from Bilibid Prison; some of whom 
appear sound, the disease being latent, but upon being obliged 
to work hard, exposed to the inclemencies of the weather of the 
colony and being poorly fed, the disease recrudesces and the 
patient is then treated in the hospital or sanatorium. 

Trancazo or influenza was the only epidemic disease regis- 
tered during the year. This disease manifested itself in an 
alarming manner November 22, soon spreading to all the inha- 
bitants^ of the colony, including the nurses and servants, so 
that there remained well only 5, without counting the employees 
and their families, who were assisted in their own houses in 
addition to other colonists lightly attacked. The disease mani- 
fested itself both alone and with complications. In the latter 
case there were noted the three forms: ataxic, cerebral and 
adynamic. The cerebral form showed a fever of 39 to 40 de- 
grees, painful joints, and grave headache, which in many cases 
produced epistaxis, and deafness through otitis, hearing being 
recovered during convalescence. The adynamic form showed a 
temperature of only 38 to 39 degrees falling to 34.5 degrees, 
great prostration, stomach cramps and sometimes slight ma- 
laise, also deafness through otitis, and catarrhal bronchitis. 
The ataxic form showed a temperature from 37.5 to 39 degrees, 
general malaise, accompanied by simple or double pneumonia, 
oppression of the chest, sometimes vomiting and diarrheal stools. 
Of the forms of grippe registered the ataxic was the gravest 
wd most complicated and caused the greatest mortality. It 



53 

was also noted that those attacked with this form in the ma- 
jority of cases had a previous history of malarial anaemia. 

During the epidemic a case was noted of a patient who had 
previously been admitted to the hospital with pustulous erup- 
tions of the skin from head to foot improving slowly with 
treatment, who on being attacked with trancazo of the adynamic 
form nearly died, but when he had completely recovered the 
skin eruptions had wholly disappeared. 

The disease is supposed to have originated from the epidemic 
which occurred in Puerto Princesa early in November, aided by 
the sudden changes of temperature, great heat during the day 
and coolness at night. 

The mortality only reached 4 per cent, a relatively low rate 
considering that in the colony there exist many cases of malarial 
anaemia, advanced pulmonary tuberculosis, debilitated old people, 
and some young children and many invalids. 

The disease is now decreasing and the danger has disappeared, 
although a few cases of benign character are still occurring. 

During the year there were 7 normal births, 6 being multipa- 
ras and one primapara. Among all of these infants, in spite ot 
the fact that they had trancazo and other diseases of infancy, 
there was not a single death. 

In view of the importance of the colony, not only on account 
of the number of its inhabitants who work exclusively for the 
Government, but also on account of the deadly malaria and other 
diseases which prevail there, it is highly necessary in the interest 
of the public service that a new modern permanent hospital be 
constructed as soon as possible; that the hospital be provided 
with a nurse for the women and children patients; that the daily 
labor of the colonists be reduced from 9 to 8 hours ; and that the 
food allowance be increased from twenty to twenty-five centavos 
per day per colonist. 

KIANGAN HOSPITAL. 

This hospital is housed temporarily in a building of mixed 
material construction. The operation of the hospital during the 
year is as follows: 

Number of patients admitted 342 

Number of patients treated in the dispensary 1,005 

Number of deaths 13 

Percentage of deaths, including deaths from grippe epidemic 

per cent.... 3.8 

Major operations _ None. 

Minor operations 60 



54 



PERSONNEL. 

1 physician (Subdistrict Health Officer.), 

1 nurse, 

1 sanitary Inspector (detailed in hospital.), 

1 cook, 

2 muchachos, 
1 laundress. 

Cost of subsistence of the patients during the year amounted 
to ^770.18. 

SAN LAZARO HOSPITAL. 

This is the only hospital in the Philippine Islands exclusively 
reserved for the care and treatment of cases of dangerous and 
contagious diseases, and although it ranks as one of the largest 
and most important institutions in the Islands, yet its capacity 
was by far insufficient to accommodate the large number of pa- 
tients during the smallpox, cholera, and influenza outbreaks. 

The following table shows the operation of the hospital during 
the year : 

Admission of patients. 



Department. 


In Hospi- 

talJanu- 

ary 1, 

1918. 


Admit- 
ted. 


Dis- 
charged. 

173 
42 
21 

404 
18 

261 

533 

780 
14 

384 
59 
34 

119 
21 
45 
6 

142 
30 


Trans- 
ferred. 

82 

260 

13 

6 

14 

28 

14 

57 

6 

10 

1 

5 

10 

1 

2 

3 

2 

7 


Escaped. 

8 
45 


Died. 


Ren ain- 

ing in 

Hospital 

January, 

1919. 


Insane . . 


437 
144 

32 
87 


326 
302 

77 
650 

34 

401 

1,079 

860 

20 
460 

75 

42 
169 

52 

48 

9 

162 

37 


122 378 


Lepers 

Aged and infirm 


10 1 89 
35 40 


Tuberculosis - 


2 


257 

2 

107 

528 

11 


68 


Under observation 




Cholera.-- 


2 


1 


Q 


Smallpox _ . 


4 


Varioloid \ 


12 




Varicella 1 . 




Measles 


4 




6 
15 

9 
40 


64 


Diphtheria 






Typhoid 


I 

1 

1 






Dysentery 




1 


Tetanus 






Venereal diseases -- - 


1 


Grippe 






Mumps 


5 
5 




2 
4 


21 


Miscellaneous - 




1 








Total. — 


725 


4.803 


3,086 


521 


68 


1.180 


673 



EXAMINATION OF LEPERS. 

The Technical Committee on Examination of Lepers examined 
274 lepers during the year, of which 243 were clinically positive, 
21 clinically negative, and 10 clinically doubtful, and 221 were 
microscopically positive, 51 microscopically negative, and 2 mi- 
croscopically doubtful. 



55 

SUBSISTENCE. 

Subsistence supplies: 

Balance on hand January 1, 1918 M,224.52 

Purchased 171,699.74 



Total 173,924.26 

Consumed 170,460.71 

Balance on hand 31, 1918 3,463.55 



Average cost of subsistence per month 14,205.06 

Average number of persons subsisted per day 824 

Average cost of subsistence per person per day 0.5746 

RECOMMENDATIONS OF THE CHIEF OF THE HOSPITAL. 

1. That the main office be removed from its present location, 
which is small and dark, and transform the pharmacy and com- 
missary bodega into an office by opening a door in the wall at the 
right hand side of the main entrance and by widening the win- 
dows thereof. 

2. That the present office be fitted up for a pharmacy and 
waiting room by altering the location of the shelves and counters. 

3. That the old dining room and room adjoining it be fitted 
up as a storeroom for commissaries and general supplies by re- 
moving the partition between them and replacing it with con- 
crete posts, fixing up the windows, and concreting the floor 
throughout. 

4. That the old iron roof building behind the contagious 
diseases wards be enlarged to one and one half of its present 
size for quarters of hospital helpers and servants. 

5. That the hospital laboratory be enlarged by removing the 
wooden partition between the laboratory room and veranda, and 
place glass windows on one side. 

6. That the bathroom be repaired and new toilets installed in 
the old building occupied by the Insane department for males. 

7. That the sinks and toilets in the new building occupied by 
the Insane department for males be repaired, and four small 
and strong cells for raving patients be built. 

8. That four flush toilets and one bathroom with four shower 
baths be installed in the Leper department for males, and -re- 
pair old toilets and bathrooms in both male and female Leper 
departments, and providing more ventilation. 

9. That the dining room for helpers and servants be widened 
and the windows screened. 

10. That an additional room be constructed near the door of 



56 

the general kitchen, on the west side, with iron roof and screened 
walls, to be used as vegetable store-room. 

11. That a new building be constructed for a nurses' dormi- 
tory with sufficient capacity for 60 beds, as the one in use at the 
present is overcrowded, the chief of the hospital being compelled 
to give up the quarters provided for the chief of the institution 
in order to provide the nurses with quarters. 

12. That 302 gold medal cots be purchased to replace the 40 
iron beds in use at the present time in order to increase the ca- 
pacity of the wards during epidemics, as follows : 

Ward. No. of cots. 

57 

1 46 

2 56 

3 56 

4 87 

Total 302 

13. That at least two additional wards, with a capacity of 
150 beds each, of the same type as the one at present under 
construction, be constructed each year until such time as when 
the hospital shall have five beds available for every lOOOpeople 
in Manila, which is believed to be a fair average to answer the 
present necessities and even those in times of epidemics. 

14. That the crematory be repaired. 

PROVINCIAL HOSPITALS. 

ALBAY HOSPITAL. 

This hospital was opened December 15, 1917, with a capacity 
of 50 beds. The number of patients treated during the year 
1918 is as follows : 

Patients remaining over from previous year 11 

Patients admitted during the year 311 

Patients discharged during the year 296 

Patients died during the year 15 

Patients remaining December 31st 11 

ADMISSION OF PATIENTS. 

By nationality: 

Filipinos 277 

Americans 4 

Spaniards 8 

Chinese 20 

Others , 2 

Total 311 

Male patients 207 

Female patients 104 

Total 311 



57 

By ages: 

Below 10 years 27 

10 to 20 years 42 

20 to 30 years 107 

30 to 40 years 52 

40 to 50 years 35 

50 to 70 years 48 

Total 311 

SUBSISTENCE. 

Number of patients subsisted during year 322 

Number of attendants subsisted during year 27 

Number of employees subsisted during year 11 

Total 360 

Total number of days subsisted 8,433 

Average number of persons subsisted per day 24 

Total cost of subsistence during year ^6,281.15 

Average expended per person per day 0.74 

Received from patients during year 5,096.87 

PERSONNEL AND SALARIES. 

1 chief nurse f»=900.00 

1 nurse 720.00 

1 property clerk and cashier 480.00 

1 practicante 300.00 

2 student nurses, ^180 each 360.00 

1 cook 240.00 

1 laundryman 180.00 

1 gardener 180.00 

2 servants, 1^150 each 300.00 

Total '. 3,660.00 

OUTDOOR CLINIC. 

Consultations (total) 369 

Treatments 204 

Operations 58 

Attendance at residence 107 

There were 74 operations performed during the year, 18 being 
major and 56 minor operations. Eight patients, seven lepers 
and one smallpox case, were treated in the contagious ward. 
Six obstetrical and 8 genecological cases were treated. 

The hospital is equipped with a complete laboratory, with the 
exception of a microscope which was ordered from the States a 
year ago. During a period lasting a few weeks the stools of all 
the patients in the hospital, 43 in all, were examined with a 
borrowed microscope. Of the 43 examinations, 37 revealed in- 
testinal parasites, mostly round and hook worm. 



58 

LEYTE HOSPITAL. 

The work of the hospital has shown a great improvement in 
the way of attracting the people to seek admission thereto. 
Sometimes the number of patients seeking admission to the hos- 
pital exceeded the capacity of the hospital, which demonstrates 
that the people both appreciate and recognize the hospital as one 
of the very necessary and most important institutions in the 
province. 

RECOMMENDATION. 

Baths and toilets, — Construction of three additional rooms — 
one for bathroom and two for toilets — in order to provide sep- 
arate bathrooms and toilets for the patients and the personnel of 
the hospital, as at the present time the actual bath and toilet 
rooms are in common use by both the patients and the hospital 
personnel. 

Night'icatchman, — Employment of a night-watchman to keep 
watch over every thing and to assist the night-nurse in the per- 
formance of her duties. 

Water supply, — To provide the hospital with four water-tanks, 
with faucets, of sufficient capacity to supply the requirements 
of the hospital at all times, as the present water supply is in- 
adequate. 

NAGA HOSPITAL. 

During the year 1918, 1,553 patients entered the hospital, as 
compared with 1,000 patients during the year 1917. There 
were 25 deaths during the year. 

Major operations 25 

Minor operations ' 145 

Surgical dressings 3,505 

Prescriptions filled 6,225 

Patient visits to hospital clinic 6,199 

More patients would have entered the hospital had there been 
accommodations for them. The patients were from Ambos Ca- 
marines, Albay, Sorsogon, and Tayabas. 

The personnel consists of the district health officer, who is 
at the same time chief of the hospital, 2 nurses, 4 practicantes, 
1 janitor, 1 cook, 1 gardener, and 4 servants. 

Appropriation has been made for an additional building for 
this hospital, to consist of operating room, laboratory, and four 
private rooms. 



59 

EXPENSES. 

Salaries of employees M,440.33 

Wages of servants 1,808.89 

Consumption of supplies and medicines 4,949.67 

Illumination 355.78 

Equipment repair service 26.60 

Building repair service 122,85 

Incidental expenses 318.63 



Total expenses, 1918 11,022.75 

Total expenses, 1917 13,504.78 

Decrease 2,482.03 

Income, 1918 6,030.00 



60 



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REPORT OF THE DIVISION OF SANITATION, CITY OF MANILA 

[Dr. Salvador V. del Rosario, Chief of Division.} 



REMAUKS OX TUF EPIDEMJOIiOGY OF THE CITY OF MANILA. 

The occurrence of the smallpox outbreak and the influenza 
epidemic within the year constitute the two principal events in 
the local epidemiology during 1918. 

SMALLPOX. 

The most remarkable feature, in. the case of smallpox, is the 
fact that from June 1909 to March 1918, the city of Manila 
suffered no loss in lives from this malady although scattered 
cases of varioloid and varicella were registered during this in- 
terval of time. It is also to be stated that although smallpox 
was absent from the city, this was not the case for the remainder 
of the Philippine Islands as considerable prevalence of the in- 
fection in certain islands (Samar, Leyte, Cebu, Occidental, and 
Oriental Negros and perhaps others) was at stated intervals 
mentioned in the annual reports of the Service. 

It is not by far an easy matter to draw an explanation of the 
reappearance of smallpox in Manila, after fully 9 years absence. 
But, if the epidemic is to be traced to the first 3 or 4 cases, it 
would prove very interesting to know that as far as the official 
information goes, the following facts have been established : 

1. The increased prevalence of smallpox in certain Southern 
Islands and the Sub-province of Davao, Mindanao prior to its 
occurrence in city of Manila. 

2. The first three cases registered in the city occurred as 
follows : 

(a) Two Tagbanwas (natives of Palawan), father and son, 
who were rescued while hanging to an upturned prow in 
Southern waters by an interisland steamer, arrived in Manila 
December 16, 1917, the father developing smallpox on the same 
date, and the son on January 1, 1918. The latter died Jan- 
uary 10. 

(6) An English sailor arrived in Manila on December 21, 
1917, from Nankin, China, and developed smallpox on Decem- 
ber 22d. 

61 



62 



A thorough survey of the epidemic incidence in Manila gives 
for the whole year 1918 the following figures: 

Incidence : One thousand three hundred twenty-six cases — 4.42 
per 1,000 population. 

Mortality: Eight hundred sixty-nine deaths — 65.53 per 100 
cases — 2.89 per 1,000 population. 

The smallpox epidemic reached its climax during April, May 
(29 cases reported during 24 hours on May 23d) and June and 
was practically brought under control during July. 

A vigorous campaign of vaccination was accordingly started, 
simply as a continuation, though far more intensified as sug- 
gested by the situation, of the annual regular vaccination of 
non-immune people. 

Four hundred fourteen thousand four hundred ten vaccina- 
tions were performed resulting in 69,579 positives or 45 per 100 
of the total inspections made, which amounts to 154,664. 

Vaccinations, 1918. 



Health district- 



No. 1, Intramuros 1 43,566 

No. 2, Meisic 119,354 

No. 4, Sampaloc I 69,715 



Vaccina- 
tions. 



No 5, Tondo. 
No. 6, Paco. 



121,639 
60, 136 



Inspec- 
tions. 



J Positive. 



7,570 
38,360 : 
31,586 ; 
29,598 : 
47,550 I 



3,118 
21.091 
14, 803 
14. 186 
16,381 



154,664 69,579 j 



Nega- 
tive. 



4,452 
17, 269 
16, 783 
15,412 
31, 169 

85, 085 



This rather low percentage of positive vaccinations, no matter 
how strange it may appear to those not familiar with a sys- 
tematic work of vaccination in large localities, may well be ac- 
counted for by a previous although partial immunity to smallpox 
enjoyed by a large portion of the city population as a result of 
the regular vaccination and revaccination performed each year 
therein. 

This pre-existing immunity of a large number of people in 
Manila is fully confirmed by these facts: 

1. Pupils of the public and private schools; officers and em- 
ployees of the government — wherever the annual systematic vac- 
cination has been thoroughly and accurately performed, proved 
quite well protected against smallpox. 

2. The severity of the epidemic was practically brought under 
control in about five months, a fact that could only be attainable 
with a partly immunized population. 

To cover, however, any possible objection to the actual po- 
tency of the antivariolic vaccine as prepared by the Bureau of 
Science, a change in the strength of the vaccine was suggested 
to and adopted by the Bureau of Science, under date of June 15, 
1918, as follows : 



63 



Usual 80 per 100 glycerine to be changed into 70 per 100 
glycerine. 

Usual dilution of 1 part of pure pulp of vaccine into 4 parts 
of glycerine changed into 1 part pulp into 3i parts glycerine. 

After more than six months experience with the modified vac- 
cine no case of vaccinia (as predicted) nor any other untoward 
effect resulted. 

INFLUENZA. 

The great pandemic of world-wide extension, through the 
whole year, exacted also a considerable number of victims in 
the city of Manila. 

Revealed first by marked increase in the mortality due to res- 
piratory diseases since the early months of the year, its presence 
as a genuine epidemic in the city has been later on recognized 
at least on two distinct occasions — the first having taken place 
during May and June, 1918, and the second, during October and 
November of the same year. 

The May-June outbreak had slight significance from an epi- 
demiological viewpoint on account of the low mortality attached 
to it ; it was not until the second recrudescence occurring during 
October and November that the attention of the health oflScials 
was most gravely attracted and surveys and serious studies 
were promptly undertaken. 

A period of but 45 days was the total duration of the second 
outbreak in the city of Manila (from October 15 to November 
30, 1918). 

The incidence in this second outbreak (perhaps better called 
"recrudescence'') amounted to about 37,950 cases (crude figure) 
representing one-eighth, or 12.5 per 100 of the city population. 
In other words, 126 cases for every 1,000 inhabitants thereof. 

The mortality was represented by 1,156 deaths (or 3 per 100 
of cases) equivalent to 3.85 deaths for every 1,000 population. 

CENSUS OF INFLUENZA OCCURRENCE IN THE CITY OF MANILA. 

Period covered — October 16, 1918, to November 30, 1918. 



Adults. 



Children. 



Total. 



Health district. 



No. 1, Intramuros 

No. 2, Meisic 

No. 4, Sampaloc-- 

No. 5, Tondo 

No. 6, Paco 

Grand total 



3,634 
3,^05 
3,410 
5,300 
4,772 



Mortal-! 
ity per Cases, 
cent. 



70 
131 
152 
114 

91 



21,021 



P. cent. 
1.9 
3.35 
4.4 
2.1 
1,9 



2.6 



2,039 
2,303 
3,023 
5,027 
4.537 



16, 929 



Deaths, 



Mortal- j 

ity per \ Cases, 'Deaths. 

cent. ; | 



General 
mortal- 
ity. 



52 I 
137 
121 
190 



P. cent.' 

2.5 i 

5.9 ; 

4. \ 
3,7 I 
2.1 i 



5,673 
6,208 
6,433 
10,327 
9,309 



122 
268 
273 
304 
189 



3.5 I 37,950 i 1,156 



P. cent. 
2.1 
4.31 
4.2 
2.9 
2. 

3. 



If the fact is considered that such a high number of cases 
(37,950) occurred in but 45 days (an average of about 843 cases 



64 

per day) one can but hardly imagine what a big problem was 
confronted by the Health Service in handling in an only fair 
manner the epidemic situation. 

Obviously, well-to-do classes were not a matter of great con- 
cern ; but not so in the case of poor and indigent people to whom 
the Service would have to furnish free attendance and care. In 
a city with very limited hospital accommodation (both official 
and private count less than ten with over 300,000 population) 
hospitals soon became packed to the limit and a rigid rule had 
to be drawn for the admission of only complicated cases of in- 
fluenza most of them being pneumonic or broncho-pneumonic in- 
fluenza cases. 

The remainder, or uncomplicated cases, were all to be attended 
and supplied with medicines at home by the medical officers of 
the Service regardless of any limitation as regards places or 
time of call at day as well as at night time. 

In regard to preventive measures against influenza, a sys- 
tematic disposal of patients through isolation, hospitalization 
and quarantine of the cases proved unpractical as has been the 
case here and abroad in localities where the epidemic appeared 
with somewhat marked severity. 

A bulletin containing prophylactic advice against influenza 
was profusely distributed among university and school pupils, 
shop-workers, tradesmen, laborers, and householders. It reads 
as follows: 

PHILIPPINE HEALTH SERVICE. 

For the information and guidance of all concerned (school teachers, 
business and workingshop managers and foremen, householders, and others) 
the following rules are issued with a view to prevent as much as possible 
the further spread of the present epidemic influenza (trancazo) in the city 
of Manila : 

HOW TO AVOID "trancazo/' 

Personal measures. — Immediate contagion can be prevented by a thor- 
ough hygienic care of the mouth and throat; frequent cleanings with a 
brush and toilet antiseptic (as a weak -solution of borax, oxygenated water, 
etc.), and gargles several times a day. Avoid also and protect yourself 
against the tiny drops of saliva or mucus contained in the breath which 
are expelled on coughing, sneezing or talking excitedly. You should keep 
a safe distance of four feet or more when talking with other persons and 
protect your mouth and nose with a handkerchief, so as to prevent danger 
to others and yourself. You should not spit promiscuously on the floor and 
other places. The sputum and saliva of the patients should be deposited in 
spittons provided with disinfectants. 

All the tableware, especially that used by a patient, should be thoroughly 
scalded (washed with hot water and soap). Also the fingers, when they 
are used for eating. 

It is a vicious and coarse habit at all times, and especially during an 
epidemic of "trancazo," to put the fingers in the nose or in the mouth and 
then shake hands with friends or infect with them things otherwise clean. 



65 



Whether sick or in health every one should sleep with a mosquito net. 

Do not send or permit children or grown persons with an incipient 
catarrh or malaise with hone-ache to attend the school, workshop, cine, 
theater, church or other places of meeting or gathering. 

PRECAUTIONS OF A COLLECTIVE NATURE. 

Daily inspection of all the personnel, excluding all those who present 
symptoms of catarrh or bone-ache. 

Prohibition of the common use of drinking glasses and towels. 

MEDICAL ASSISTANCE. 

Patients need not go to a hospital. They may be attended by their own 
physician in their homes. 

Poor persons may have the services of a health-doctor as soon as the case 
is reported to the corresponding station. 

Anti-influenza vaccination is still in its experimental stage. 

TYPHOID FEVER, DYSENTl^KY, AND CHOLERA. 



191 



1918 



Typhoid: 

Cases 

Deaths 

Death-rate (per 100 cases) 

Incidence (per 1, 000 population) 
Mortality (per 1, 000 population) . 
Dysentery: 

Cases 

Deaths 

Death-rate (per 100 cases) 

Incidence (per 1, 000 population) 
Mortality (per 1,000 population) 



525 
199 
37.9 
1.79 
.68 

851 
294 
34.54 
2.92 

1 



497 
118 
23.74 
1.65 
.39 



218 
25.98 
2.79 
.72 



From the above summary in which figures represent facts of 
unquestionable epidemiological interest, it is plain that a distinct 
though slight improvement is noticed in both typhoid fever and 
dysentery. This fortunate result is almost wholly traceable to 
a more thorough and accurate reporting of the cases which 
brings about a far more satisfactory disposal of the cases — better 
home isolation, if not hospitalization of the case, continuous con- 
current disinfection of the patient's discharges and other pre- 
cautions as regards food, drink and soiled fingers, all of which, 
experience has shown to be most instrumental in doing away 
with "contact infection'' the well known local evil. It is firmly 
hoped, in this connection, that a faithful observance of the 
Health Service regulations in regard to the management of ty- 
phoid and dysentery cases will in time secure a steady decrease 
in the incidence and mortality of both diseases to the ideal mi- 
nimum practically equivalent to their eradication. 





1917 


1918 


Cholera _.. . . _ 


25 

8 

32 

0.08 
0.02 




Cases (positive bacteriology) 


182 


Deaths _ - 


123 


Death-rate (per 100 cases) 

Incidence (per 1,000 population) . _ _ 


67.58 
.60 


Mortality (per 1, 000 population) __ 


.41 






168426 5 







66 

Cholera, on the other hand, has run this year a rather pecul- 
iar course in that, while practically absent during the first 
eight months, made a sudden appearance in September with a 
well marked apex in October and then decreased gradually to- 
ward the end of the year. 

The peculiarities of this so-called outbreak of cholera are as 
follows : 

1. No increase in the number of carriers prior to the appear- 
ance of choleifa contrary to what has been observed in previous 
outbreaks with a well maintained survey for carriers. 

2. A surprisingly large number of cases reported as cholera 
but found ''negative" bacteriologically. 

3. The high fatality of cases (67.58 per hundred) as com- 
pared with previous outbreaks the average fatality of the latter 
being nearly 33 per 100 as a rule. 

Remarks 2 and 3 are fully substantiated by a careful perusal 
of the following table: 



Month. 



January ___ 
February ._ 

March 

April 

May 

June 

July 

August 

September . 

October 

November _ 
December _ _ 

Total - 



reported.! 



Cases 

found 

positive. 




If to the above circumstances, the fact is added that the out- 
break made its appearance just during the months of the year 
(especially October and November) in which influenza showed 
its highest prevalence in the city of Manila, it appears that all 
the reasons tend to uphold the view that this cholera outbreak 
rather than being one of the genuine endemic type alone, was 
hig'hly favored, if not entirely determined by the existence of 
a few vibrio-carrying cases the virulence of the vibrio having 
suddenly been enhanced by an increased susceptibility of the 
individual due to a previous possible unrecognized attack of 
influenza. 

Epidemic or pandemic influenza is now conceived much as due 
to an unknown virus which causes in the system a condition of 
poisoning revealed in two fundamental signs or symptoms, 
namely: (a) clinically, a prof ound prostration probably due to an 
injurious effect of the virus upon the nervous system, and (&) 
pathologically, a poisonous dyscrasic condition of the blood which 



67 

manifests itself in an hemorrhagic tendency and a marked leuco- 
penia, indicating depressed activity of the bone marrow, and 
also a greatly lowered resistance to secondary infection. It is 
at present assumed that aside from these two essential symp- 
toms, the varying clinical pictures following them belong all to 
secondary (overlapped) infections highly favored by a condition 
of hipersusceptibility as brought about by the influenza attack. 

Admittedly these secondary or associated infections (so-called 
influenza complications) most often affect the air passages, from 
the nose and throat to the pleura (nearly 90 per 100 of cases), 
but there still are a number of other visceral involvements which 
give room for the wellknown cerebral or meningitic and abdom- 
inal among other forms of influenza. This theory would also 
give full account of the well observed fact of the increase in 
number, during influenza epidemic times, of all diseases either 
respiratory or otherwise. 

In the case of cholera and other intestinal infections the prin- 
cipal incumbency rests on the ''bacillus carrying'' condition which 
means a latent existence of the specific germ, the normal aggres- 
siveness of which is overcome by a high power of resistance 
in the carrier. Should this power of resistance be seriously 
lowered for some reason (previous influenza attack), then the 
typical infection would promptly make its appearance. As 
regards typhoid fever and dysentery, the case would be some- 
what different from that of cholera infection, as typhoid and 
dysentery have proved, in repeated surveys, not specially con- 
cerned in or productive of the bacillus-carrying condition. As 
a matter of fact, however, a number of indications tend to show 
that typhoid fever and dysentery did not remain unaffected by 
the pandemic influenza during 1918. 

Thus, the tables of prevalence show that for typhoid fever the 
only striking increase in the incidence occurred in October while 
for dysentery the increase was surprisingly high in August, 
September and October more or less coresponding to the highest 
prevalence of pandemic influenza, to say nothing of nonconfirmed 
(negative) cases of suspected cholera which lately in the course 
of the disease were suspected or recognized cases of typhoid or 
dysentery or other trivial (colibacillary) forms of intestinal 
disturbances without any corresponding change in records where- 
in they continued to be branded as cholera suspect cases. 

It is not claimed from the above facts that the presence of 
cholera has exclusively been due to an intervening role played 
by influenza. The purpose is only to draw the attention of the 
reader to the fact that this role has been of decided importance 
in setting in the unexpected appearance of cholera. Obviously, 



68 

once the outbreak started this could follow a gradually separate 
independent course and existence, as the exciting factor (in- 
fluenza) was going to its decline. 

The following figures speak by themselves: 



Year. 


September 

October 

November 

December 

January 


Month. 


Per 100 .of 
ipositives. 


Mortal- 
ity. 


1918 







^ 45.45 

! 41.62 

: 71.42 

^ 79.16 

1 81 81 


40. 


Do - . 


89 61 


Do 

Do 


60. 
47.36 


1919 - . 


50 


Do 


February 

March 




i 50. 

j 77.77 


20. 


Do ._-. 


35. 71 







Certainly, if some conclusion is to be drawn from these figures, 
it would be the decidedly inverse ratio which has been noted 
between the percentage of cholera cases found positive and the 
mortality attached thereto, in other words the unquestionable 
part played by influenza in this cholera outbreak. 

DIPHTHERIA. 

Once again diphtheria, while proving itself an illness of not 
much concern to the epidemiologist as shown in the table below, 
still offers certain unsolved points in its occurrence and fatality 
as pointed out in last year's report for the city of Manila, to wit : 

(a) The comparatively high mortality attached to the disease 
whether or not confirmed bacteriologically and with the pre- 
cautionary aministration of curative doses of diphtheria anti- 
toxin. 

{b) The participation of other non-specific factors in the 
causation of the illness. 



Diphtheyna in the city of Manila for the year 1918. 



Month. 


Total ca- 
ses re- 
ported. 


Positive clinically 
and bacteriologi- 
cally. 


Positive clinically 
only. 


Total found posi- 
tive. 
















Cases. 



Deaths. 


Cases. Deaths. 


Cases. 


Deaths. 


January 


16 





15 4 


15 


4 


February 


5 


1 


1 


4 1 


5 


2 


March 


9 








5 


5 1 


April 


10 








9 ; 3 


9 ! 3 


May 


3 








2 j 1 


2 1 


June 


4 








3 i 1 


3 i 1 


July . 


5 








2 1 1 


2 1 


August 


y 




















September 


1 








1 


1 


1 


1 


October 


5 


1 











1 





November 


6 




















Decernber 


3 








2 


2 


2 


2 


Total 


70 


2 


1 


43 


14 


45 


15 


Per cent positive 




2.80 




61.42 1 


64 28 ' 


Death rate 




50.00 




32.55 




33.33 



69 
DIPHTHERIA CARRIERS. 

Different surveys made to localize diphtheria carriers in the 
city of Manila (both schools and households) gave as a result 
the detection of four (4) carriers during the whole year, viz., 
1 in January, 1 in February, 1 in March and 1 in April, none 
of them in the schools as was the case in 1915, when conditions 
v/arranted diphtheria to be aptly termed a school-borne disease 
in so far as it concerns the city of Manila. 

Measles. 



Cases. 



January ._ 
February . 

March 

April 

May 

June 



July . 

Aug-ust 

September _ 

October 

November .. 
December .. 

Total . 



Death. 



103 





185 





138 


1 


77 


1 


57 


1 


16 





1 











1 





6 





2 





8 






HYDROPHOBIA. 

Numerical i eport of the incidence of rabies in dogs ai i in persons^ in the 
city of Manila, during 1918. 

[By months.] 



Month. 


Number of 

suspected dogs 

examined. 


Number of 
persons bitten by 
suspected dogs. 


Examin- 
ed. 


Found 
po ntive. 


Persons 
bitten. 


Contract- 
ed the 
disease. 


January . 


12 

17 
3 
9 

18 
6 
5 

11 

I 

7 
9 


a2 

3 

3 

bl 

1 



e2 
1 
4 



12 
12 
2 

11 
13 
7 
5 
8 
9 
6 
5 
9 





February :_. 





March 





April 





May _. ._ . 





June 





July 





Aug-ust 

September. .. 






October 





November 

December ._ .. 










Total - 


112 


17 


99 









Percent positive.. 




15.17 




None. 









" 1 suspicious. 



^ 1 suspicious. 



suspicious. 



70 



Numerical report of the incidence of rabies in dogs and in persons, in the 
city of Manila, during 1918 — Continued. 



[By districts.] 





District. 


Num 

suspect 

exan' 

Examin- 
ed. 

17 
44 
21 
9 
21 


ber of ' 
ed dogs ) 
ined. i 

Found 
positive, j 

j 

a3 i 
b5 

5 

1 

17 1 


Number of 
persons bitten by 
suspected dogs. 




Persons 
bitten. 


Contract- 
ed the 
disease. 


No. 1, Intramuros 




17 
44 
14 
10 
14 

99 





No. 2, Meisic 

No. 4, Sampaloc _. ._ . 






No. 5, Tondo . _ _ 





No. 6, Paco-._ 











Total 


112 











Percent positive 




15.17 j 

i 




None. 











" 1 suspicious. 



' 2 suspicious. 



RAT CAMPAIGN. 

Rats caught by springs traps 70,990 

Rats caught by wire traps * 31 

Rats found poisoned 3,738 

Rats caught by dogs 6 

Rats killed by clubs and other weapons 11,745 

Rats found dead from other causes, probably by poison 3,333 



Total 89,843 



Complaints received during the year.. 
Complaints attended 



Sanitary orders, rat-proofing . 

Sanitary orders remaining from December 31, 1917... 
Sanitary orders issued 



707 

707 



35 
3 



Total 

Sanitary orders completed 

Sanitary orders pending action by fiscal.. 
Sanitary orders awaiting action 



38 



23 
6 
9 



Total 



38 



Sanitary orders, cleaning. 



Sanitary orders remaining from December 31, 1917 

Sanitary orders issued 3,577 

Sanitary orders completed 3,570 

Sanitary orders awaiting action 7 



71 

Mosquito and fly extermination. 

Houses inspected during the year 136,996 

Houses where breeding places were found 11,376 

Breeding places found in houses 12,937 

Vessels ordered emptied or removed 11,113 

Drains ordered cleaned 6,660 

Lineal feet of drains ordered dug ^ 1,985 

Breeding places oiled on private premises 112,717 

Breeding places olied on public properties 89,972 

Water receptacles overturned 12,112 

Square feet of grass ordered cut 376i 

Cans of oil used 2,419i 

Sanitary orders issued 1,828 

Insanity conditions reported to health stations 145 

Number of complaints attended 524 

Number of fines: 

P=2 each 2 

3 ....do 22 

5 ....do 83 

8 1 

10 each 9 

15 1 

20 each 2 

70 1 

75 1 

Fly inspector's report. 

Stables inspected during the year 12,489 

Stables ordered cleaned 8,732 

Stables cleaned 7,594 

Market inspections made 182 

Report of disinfections. 

Cholera 2,422 

Diarrhea 11 

Diphtheria 145 

Dysentery 1,704 

Disinterments of human remains 182 

Enteritis 6 

Gonorrhea 2 

Influenza 645 

Leprosy 74 

Measles 38 

Meningitis 1 

Mumps 32 

Pertussis 1 

Pneumonia 8 

Smallpox, varioloid and varicella 1,934 

Tuberculosis 277 

Typhoid fever 707 

Disinfections of public midden sheds 15,032 

Total 23,221 



72 
Action taken on application for licenses. 



Kind of licenses applied for. 



Liquor: 

First class bars 

Second class bars 

^ First class bars and restaurants 

Second class bars and restaurants. 
Thircf class bars and restaurants _. 

Grocer i es 

Wholesale 

Druggists 

Theatres 

Hotels . 



Restaurants 

Lodging houses 

Boarding houses 

Native wines 

Cooked foods, fruits, vegetables, soft drinks and bakery products. 

Second hand articles 

Barber shops 

Barber shops (additional chairs) 

Laundries 

Public vehicles 

Livery stables 

Billiard and pool tables 

Dyeing and cleaning establishments 

Manufacturies 

Grocery stores 

Clubs - 



Advertising agencies 

Theatres and cinematographs . 
Bowling alleys 

Garages. 



Additional automobiles 

Bicycle for hire 

Blacksmith shops 

Distilleries 

Draying establishment 

Foundries 

Pawnbrokers 

Permit to sell fruits, vegetables, etc . 

To operate a slot machines 

Ice cream and iced mongo 

Bakeries 

Contractor for electric installations . 

Boarding stables 

Horseshoeing establishments 

To operate bancas 

Drying and selling fish 

White taju 

Tattooers 

Junk shops 

Permit to sell sugar 

Forges . 



Dairies 

To operate a slot machines 

To store combustible materials 

Permit to sell dried and salted fish . 
Permit to preserve and can fruits _. 

Storage of sugar 

Tanneries and selling leather 

Permit to sell vinegar 

Stock yards 

Shooting galleries 

Undertaking establishments 

Breweries 

Auctioneers 

Hot coffee stands 

Race tracks 

Public warehouses 

To sell varnish preserver 

Embalmers 



Total . 



Ap- 


Disap- 


Total 
acted 
upon. 


proved. 


proved. 


5^ 


1 


60 


9 




9 


36 


1 


37 


10 




10 


1 




1 


66 




66 


29 




29 


11 

39 




11 




5 


1 


40 


479 


65 


544 


9 


1 


10 


36 


2 


38 


2.448 


58 


2,506 


2, 163 


122 


2,285 


138 


1 


139 


490 


15 


505 


1 




1 


60 


8 


68 


517 


67 


584 


27 


2 


29 


93 


7 


100 


40 


1 


41 


410 


21 


431 


211 
54 




211 


3 


57 


1 




1 


22 




22 


1 




1 


37 


1 


38 


9 




9 


22 





22 


82 


1 


83 


17 


1 


18 


7 


1 


8 


11 
42 
631 




11 




42 


19 


650 


2 




2 


80 


11 


91 


42 


1 


43 


3 




3 


7 


2 


9 


22 


4 


26 


5 


1 


6 


1 




1 


13 


2 


15 


11 




11 


32 




32 


18 




18 


20 


3 


23 


5 


1 


6 


2 




2 


13 




13 


19 




19 


2 




2 


16 
9 
6 
3 

1 
8 




16 




9 




6 




3 




1 


i 


9 


2 
3 




2 




3 


1 




1 


1 




1 


1 




1 


1 




1 


3 




3 








8.675 


425 


9,100 



73 



SUPERVISION OF WATER SUPPLIES. 

Samples of drinking water examined during the year 1918, 



Health District- 



No. 1, Intramuros 

No. 2, Meisic 

No. 4, Sampaloc -. 

No. 5, Tondo 

No. 6, Paco 

Total 



248 
727 
354 
914 

758 



Bacterial count — 



117 : 
533 

240 : 

652 ' 
529 : 



131 : 
194 
114 
256 ; 
229 



108 
230 
129 
344 
271 



10 : 1,082 . 



41 

59 '• 
42 ^ 
97 ! 
93 I 



37 I 

162 ■■■ 
69 j 
174 I 
162 i 

604 : 



»H j Vh 



w 




a; 








c3 


m 










bJO 


CJ 


a 








fc 


U 


135 


388 


354 


242 


189 


78 


494 


282 


368 


147 


1,540 


1, 137 



S 


^ 


CO 




W. 


^ 




P. ct. 


41 


16. 53 


59 


8.11 


46 


12. 99 


103 


11.26 


93 


12.26 



342 I 11.39 



FINES IMPOSED. 

District No. 1, Intramuros MO.OO 

District No. 2, Meisic 120.00 

District No. 4, Sampaloc 174.00 

District No. 5, Tondo 50.00 

District No. 6, Paco 120.00 

Total 504.00 

SANITARY ORDERS. 

Minor orders issued by assistant sanitary inspectors. 









District — 








No. 1. 


No. 2. 

1,674 
1,674 


No. 4. 


No, 5. 


No. 6. 


Total. 


First minor orders issued 


2,926 

2,424 

505 

505 


571 
571 


677 ! 66 


5,914 


First minor orders complied with 


661 
16 
16 


66 


5,396 
521 


Second minor orders complied with 

Prosecutions 








521 


































Cases in which imprisonment was im- 
posed . -_ . _ 




1 








Cases dismissed or defendant acquitted. 














i 









74 

Garbage can orders, station orders {miscellaneous), and recommendations 

for sewer connection. 







Health c 


listrict— 




25 61 


Recom- 
men- 
dation 
for sewer 
con- 
nection. 


No. 1, Intramuros 







No. 2, Meisic 






680 


1,900 ' 52 


No. 4, Sampaloc . . 






9 


147 2 


No. 5, Tondo 






65 


217 


No. 6, Paco 






77 ' 


201 












Total - . 


856 : 


2, 526 54 




Clean-up we 






1 

December. 






ek during the month of 






Places founc 
A.a B.b 


1 insanitary. 


Insanitary conditions corrected. 


£-:.», 


Health district- 


C.c 


D.d 

1,595 
4,829 

329 
2,324 

984 

10,061 


A.H B.b 

877 i 709 
1,605 i 177 

347 1 216 
5,881 ! 2,525 

387 1 546 

9, 097 4, 173 

1 


C.c D.d 

507 'i 1,365 
411 i 4,101 
238 ■ 204 
166 2,287 
492 , 984 

1,814 i 8,941 

1 


No. 1, Intramuros 

No. 2, Meisic 

No. 4, Sampaloc. 

No. 5, Tondo 

No. 6, Paco 

Total 


1,349 
1,897 

542 
6,024 

600 

10,412 


844 
225 
273 
3,100 
786 

5,228 


751 
520 
290 
166 
654 

2,381 


1 

7 ' 20 

8 i 14 
5 i 17 

16 ' 27 

9 1 27 

45 105 

! 



' Improper handling of drinking water. 
' Mosquito breeding- places. 
■ Domestic animals. 
' General cleaning. 



MEDICAL INSPKCTIOX OF SCHOOLS. 

The inspection work of this division has been conducted in 
general under the same plan as detailed in the report for the 
year 1917. The personnel employed in this branch of the 
Service consisted of 2 medical inspectors and 5 nurses, and the 
work has been limited to the inspection of school pupils and 
clinical treatment of those found to be sick. The purpose to ex- 
tend the supervision to the pupils' homes and families could not 
be carried out because the increase in the number of nurses 
to ten, as was requested to the Municipal Board last year, 
was not approved. However, it is a satisfaction to be able to 
state that this matter has met with the approval of said Board 
for the present year of 1919, and ten nurses are now actually 
working. 



75 

A new dental clinic has been installed in the Southern part 
of the city and one more dentist was appointed to take charge 
of it. So there are at present 2 dental clinics for school chil- 
dren: 1 in Meisic for those north of the Pasig River and 1 in 
Paco for those south of it. 

In general the physical condition of the students in the schools 
has compared very favorably with that of the previous year. 

During the month of December the medical inspector in 
charge of the schools south of the Pasig River delivered a series 
of lectures to the girls of the Philippine Normal and Manila 
high schools on sanitary living. 

The following tables, A, B and C, clinical work, inspection 
work, and dangerous communicable diseases, show the work 
performed in this division during the year. 

Table A shows the clinical work performed monthly in the 
health stations of the city and compared with that of the year 
1917 a reduction of 18,336 treatments is shown. The proportion 
of recoveries among the children treated shows also an im- 
provement in the service because in 1917 there were 1,117 
recoveries out of 84,353 treatments while in 1918 there were 
1,405 out of 66,017. 

In connection with the inspection work, the Service has been 
improved, although the personnel was not increased in number. 
There were 41 schools under the supervision of this division 
with a total of 26,055 pupils inspected in the first inspection 
made. Of the 41 schools, 7 were inspected 4 times ; 19, 3 times ; 
8, twice; and 7 only once. During the year 1917 there were 
40 schools under the supervision of this division, and out of 
them only 25 were inspected twice within the year. • 

With regard to epidemic diseases. Table C shows that 
they did not seriously affect the school children, though there 
was a strong outbreak of smallpox during the year. The epi- 
demic of influenza, which invaded a large proportion of the 
population, affected the school children in a proportion of about 
13 per cent, more or less, though the records are incomplete in 
this respect. 



76 



Table A. — Clinic ivork. 



Month. 



January . 



February - 



March 



April . 



llNo. 1, 
i No. 2, 
.•No. 4. 
; No. 5 
I No. 6, 

■(No. 1, 
I No. 2. 
'{Ho. 4, 
1 No. 5, 
,INo. 6, 

'(No. 1 
;|No. 2. 
J-^No. 4 
i No. 5, 

ilNo. (), 



May . 



June. 



July. 



August . 



September. 



October 



December 



{No. 1 
No. 2 
No. 4 
No. f] 
No. 6, 

(No. 1 
No. 2. 

{No. 4, 
No. 5, 
'No. 6, 

(No. 1 

No. 2, 
No. 4, 
No. 5, 
I No. 6, 

!No. 1, 
No. 2, 
No. 4, 
No. 5, 
No. 6, 



No. 1, 
No. 2, 

No. 4, 
No. 5, 
No. 6, 

INo. 1, 
No. 2, 
No. 4, 
• No. 5, 
'No. 6, 

(No. 1 
No. 2, 
INo. 4 
i No. 5, 
1 1 No. 6, 

INo. 1, 
No. 2, 

I No. 4, 
No. 5, 

I No. 6, 

I No. 1 
No. 2, 

I No. 4, 
No. 5, 

I No. 6, 



Clinic districts - 



I Num- 

i ber of 

opera- 



Intramurcs . 

Meisic 

Sampaloc .-- 

Tondo 

Paco 



Intramuros . 

Meisic 

Sampaloc 

Tondo 

Paco 



Intramuros . 

Meisic 

Sampaloc .. - 

Tondo 

Paco 



Inti-amuros . 

Meisic 

Sampaloc . _ . 

Tondo 

Paco 



Num- 
ber of 
treat- 
ments. 


Nu 
ber 

CUl 


m- 
of 
ed. 


1, 794 


17 


1,811 




42 


1,798 




47 


1,457 




30 


40 






1, 290 




60 


1, 083 




49 


1,058 




29 


2, 125 




40 


56 




12 


1, 730 




165 


1,397 




62 


1,082 




59 


1,211 




32 


72 




4 


309 






252 






80(5 




7 


1,275 




15 



Intramuros . 

Meisic 

Sampaloc 

Tondo 

Paco 



900 . 
949 ■ 
1,(132 



Intramuros . 

Meisic 

Sam})aloc ._- 

Tondo 

Paco 



1,514 ' 

1,288 : 

1,220 i 
1,044 - 



Intramuros - 

Meisic 

Sampaloc .-. 

Tondo 

Paco 



2,863 i 
1,675 . 
1,490 ! 



32 

"20 



Inti'amuros 


' 1,329 




Meisic . . 


• 1,950 


34 


Sampaloc.- . 


_ ! 1,095 


33 


Tondo 


■ 1.395 


16 


Paco i 





81 
41 
22 



Intramuros.. . _. 




1,769 !. 
3,763 : 
1,415 ^ 
1,650 ! 




Meisic . . 




139 


Sampaloc. . . 




28 


Tondo .. . . 


22 


33 


Paco 




Intramuros 

Meisic 




1,509 ' . 
2.330 : 

1,692 ; 
1,585 : 


79 


Sampaloc 

Tondo 


.- 


25 
22 


Paco . ... 




Intramuros . 




737 . 
1,405 I 
1,052 

1,530 ; 




Meisic . .. 




36 


Sampaloc . . 





5 


Tondo 

Paco ... 


2 


25 


Intramuros. .. 




1,145 - 
1,2^1 : 
979 i 
1, 185 




Meisic . . . . . 




19 


Sampaloc. .. .. 




4 


Tondo 

Paco 


2 


15 




35 


66,017 1 


1,405 



77 



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DIVISION OF SANITATION IN THE PROVINCES 

[Dr. EuGENio Hernando, Chief of Division.] 



I. 
ORGANIZATION. 

At the close of the calendar year 1918, twenty provinces per- 
taining to this division were organized into 215 sanitary divi- 
sions, five into twenty-six municipal health districts and six 
into 126 boards of health. In this organization are comprised 
763 municipalities of the 821 that this Division embraces. 

Six of these provinces — Sorsogon, Mindoro, Nueva Ecija, 
La Union, Rizal, and Pangasinan — were organized into sanitary 
divisions during the year. Four other provinces — Bataan, Ca- 
vite, Laguna, and Samar — have passed resolutions by which 
their organization into sanitary divisions will be effective on 
January 1, 1919, and it is expected that during the year 1920 
all the provinces embraced in this division will be organized in 
accordance with the provinsions of Chapter 37, Article VIII, of 
the Revised Administrative Code. 

The provincial health organizations are managed by thirty- 
three district health officers, who are all physicians and have 
their headquarters in the capital of the province assigned to 
them; and by 215 presidents of sanitary divisions, of whom 
202 are physicians, and 13 cirujanos ministrantes, or graduate 
nurses. Sixty-four district nurses; twenty-one midwives; and 
789 sanitary inspectors are the subordinate personnel of the 
physicians. 

The health districts into which the Islands are divided are 
as follows: 

79 



80 



No. of health 
district- 
First 

Second 

Third 

Third 

Fourth 

Fifth 

Sixth 

Seventh 

Eighth 



Ninth 

Tenth 

Eleventh. 



Twelfth 

Thirteenth.. 
Fourteenth . 
Fifteenth ._. 
Fifteenth ._. 
Fifteenth ... 



Sixteenth 

Seventeenth 

Eighteenth 

Nineteenth 

Twentieth 

Twenty-first a 

Twenty-second » . 

Twenty-third 

Twenty-fourth , . . 
Twenty-fifth .... 

Twenty-sixth 

Twenty-seventh . 
Twenty-eighth a . 
Twenty-ninth ... 

Thirtieth 

Thirty-first 



Province. 



Cagayan 

Ilocos Norte 

La Union.. 

Zambalea 

Rizal .. 

Nueva Ecija 

Pangasinan 

Tarlac 

Pampanga and Bataan.. 

Bulacan .. .. 

Laguna 

Tayabas 

Sorsogon and Masbate... 

Ambos Camarines 

Mindoro ' 

Antique 

Capiz 

Iloilo 

Batangas 

Albay 

Occidental N egros 

Cebu 

Bohol 

Surigao 

Misamis 

Samar 

Leyte 

Mountain Province 

Oriental Negros 

Isabela 

Agusan 

Ilocos Sur and Abra 

Romblon 

Cavite 1 



Rank. 



Medical inspector 

Senior surgeon 

Surgeon 

Assistant surgeon 

Medical inspector 

Medical inspector 

Medical inspector 

Medical inspector 

Senior medical in- 
spector. 

Medical inspector 

Medical inspector 

Senior medical in- 
spector. 

Medical inspector 

Medical inspector 

Assistant surgeon 

Assistant surgeon 

None 

Senior medical in- 
spector. 

Senior surgeon 

Senior surgeon 

Senior surgeon 

None 

Medical inspector 

Senior surgeon 

Senior surgeon 

Assistant surgeon 

Medical inspector 

Medical inspector 

Surgeon 

None 

Medical inspector 

Surgeon l._. .. 

Assistant surgeon 

Assistant surgeon 



Name of district health 
officer — 



Dr. F. Lopez Lubelza. 
Francisco Ontanon. 
Guillermo Zandueta. 
Jose Zarraga. 
F. Gonzales Siojo. 
Jose Bantug. 
Jose Lopez Rizal. 
Juan Nepomuceno. 
Luis Caballero. 

Manuel Ramirez. 
Vicente Rivera Sayo. 
Rafael Villafranca. 

Felino Simpao. 
Gavino Vinluan. 
Luis Gomez. 
Bartolome Cella. 
Jos6 Vidal. 
Andres Catanjal. 

Pacifico Laygo. 
Shannon Richmond. 
Donato Montinola. 
Alfonso Raquel. 
Manuel Ma. Aycardo. 
Constantino Limjoco. 
Francisco Xavier. 
Anatolio Dasmarinas. 
Jos6 Guidote. 
Gabriel Intengan. 
Jose Raymundo. 
Jose Purugganan. 
Florentine Ampil, 
Marciano Crisologo. 
Clodoaldo Abad. 
Eufemio Jara. 



^ Health districts pertaining to the Division of Mindanao and Sulu. 



The following tabulation marked with letter A shows the 
health organization of this division and the sanitary personnel 
assigned thereto during 1917 as compared with the year 1918. 

Changes in the personnel. — The chief of this Division, Dr. 
Paul Clements, was called to the U. S. Army in the month of 
February and Medical Inspector Dr. Eugenio Hernando, district 
health officer of the Province of Bulacan, was assigned to tem- 
porarily relieve him until September 7, on which date he was 
appointed as chief of said division. 

The following promotions were made during the present year 
in this division: 

From senior surgeon to medical inspector: 

Dr. Victorino de los Santos. 

Dr. Jose Avellana Basa. 

Dr. Felino Simpao. 

Dr. Jose Guidote. 

Dr. Manuel Ma. Aycardo. 
From surgeon to senior surgeon : 

Dr. Francisco Ontanon. 

Dr. Jose Raymundo. 

Dr. Bonifacio Mencias. 

Dr. Enrique Ochoa. 



81 






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82 

The following commissioned officers resigned: 

Senior medical inspectors: 

Dr. Gilbert I. Cullen. 

Dr. Arlington Pond. 

Dr. Claude E. Norris. 
Senior surgeons: 

Dr. Domingo Santos. 

Dr. Andres Bautista. 
Surgeons : 

Dr. Guillermo Jimenez. 

Dr, Jose Chaves. 

The following commissioned officers were separated from the 
service for the causes stated below: 

Chief of Division Dr. Paul Clements, died June 29, 1918. 
Senior Medical Inspector Dr. Zach M. Laughlin, retired. 

The following officers of the Service were transferred from 
one assignment to another: 

Senior medical inspectors: 

Dr. Andres Catanjal transferred from district health officer of 

Tarlac to district health officer of Iloilo. 
Medical inspectors: 

Dr. Gabino Vinluan transferred from district health officer of 

Nueva Vizcaya to district health officer of Ambos Camarines. 
Dr. Jose Bantug transferred from district health officer of 

Nueva Ecija to chief of the Culion Leper Colony. 
' Dr. Victorino de los Santos transferred from subdistrict health 

officer of Calinga, Mountain Province to district health 

officer of Nueva Vizcaya. 
Dr. Jose Avellana Basa transferred from special duty to the 

office of the chief of division of sanitatiort in the provinces. 
Dr. Felino Simpao transferred from district health officer of 

Sorsogon to Manila as officer in charge of the Extra- 
cantonment Zone, Camp Claudio. 
Dr. Manuel Ma. Aycardo transferred from sub-district health 

officer of Kiangan and Ifugao, Mountain Province to district 

health officer of Bohol. 
Dr. Manuel Ramirez transferred from the office of the chief of 

the division of sanitation in the provinces to district health 

officer of Bulacan. 
Senior surgeons: * 

Dr. Felipe Arenas transferred from special duty to district 

health officer of Nueva Ecija. 
Dr. Bonifacio Mencias transferred from special duty to Extra- 
cantonment Zone, Camp Claudio. 
Surgeons : 

Dr. Juan S. Fernando transferred from special duty to district 

health officer of Sorsogon. 



83 

The following officers served in the U. S. Army Medical Corps : 

Chief of Division Dr. Paul Clements. 
Senior medical inspectors: 

Dr. Arlington Pond. 

Dr. Almon P. Goff. 

Dr. Henry Pick. 

and in the Philippine National Guard Medical Corps, the fol- 
lowing: 

Senior surgeons: 

Dr. Pacifico Laygo. 

Dr. Jose Raymundo. 

Dr. Enrique F. Ochoa. 
Presidents of sanitary division : 

Dr. Ramon Sta. Ana. 

Dr. Pedro Buenseda. 

Dr. Virgilio Gonzalez. 

Dr. R. Perez. 

Dr. Caspar Garcia. 

Dr. Eliseo Bundoc. 

Methods of securing prompt information, — Telegraph, tele- 
phone and mail are the methods available for securing prompt 
information from the provinces comprised in this division. 

Telegrams are used solely in emergency cases and to report 
daily the situation of any prevailing epidemic. 

Information by telephone can be obtained in eighteen prov- 
inces only, the rest of the provinces sending their reports or 
information by mail or telegraph. 

In the provinces where the municipalities are connected by 
means of a telephone system, this means is used in the daily 
report of cases or deaths from communicable diseases, and of 
any other matter requiring immediate action. As soon as any 
real or suspicious case of a communicable disease is discovered 
in any health district, notification of the case to the Central 
Office is required, and daily reports of further cases and deaths 
registered from the disease are submitted until such time as 
the epidemic is put under control. 

With a view to making this division aware of the most accu- 
rate condition of the provinces it comprises, uniform weekly 
reports are required from each district health officer. These 
weekly reports are divided into five sections: Section A, statis- 
tics of total mortality and mortality under one year of age; 
Section B, statistics of mortality of most common diseases; 
Section C, statistics of mortality of communicable diseases; 
Section D, inspections; and Section E, miscellaneous. 



84 

Figures showing the total mortality and the mortality under 
one year of age by provinces are compared with the mortality 
for the corresponding period of the previous year. Any in- 
crease in the mortality is immediately investigated. 

The same procedure is followed when increase in the number 
of deaths registered by the most common diseases and commu- 
nicable diseases is elicited from the comparative study of Tables 
B and C of the weekly reports. 

In Section D (Inspections), the district health officers are 
required to give a short statement of the daily inspection work 
done ; the reason for such inspection, and the sanitary measures 
taken to remedy insanitary conditions found in their respective 
health districts, and in connection with the control of epidemics. 

In Section E (Miscellaneous), the district health officers are 
required to state briefly any event of special mention that might 
be of use to the Central Office. 

In this way the Central Office in Manila has at all times a 
complete control over all the health districts in the Islands and 
is always ready to answer any call for help from any locality 
where aid is needed by sending personnel, materials, or similar 
other aid to said localities according to their need. 

Several health organizations have provided automobiles for 
their district health officers, and the use of this kind of tran- 
sportation makes possible the immediate investigation of a case 
of communicable disease, the prompt application of pertinent 
sanitary measures as well as the inspection of their district and 
the supervision of the work of subordinates. 

Circulars, — Eighty-nine circulars have been issued by the 
Central Office during the present year, the following having 
reference to the work of this division: 

Q-3. — Collection of lepers scattered throughout the provinces. 

Q-5, — Handling of dead bodies caused by communicable diseases. 

Q-9. — ^Directing district health officers to make the preliminary physical 

examination of recruits in the Philippine National Guard. 
Q-13. — Re persons entitled to free medical attendance. 
Q-14. — Instructions to carry out vaccination work in the provinces. 
Q-17. — Instructions to carry out vaccination work in the provinces and 

care in the use of vaccine virus. 
Q-18. — Making persons, firms, corporations or associations having control 

over any medium of transportation responsible for any unlawful 

transport from place to place of persons sick or suspected of 

communicable diseases. 
Q-19. — Regarding administration of women^s clubs and puricultural centers. 
Q-20. — Campaign for the Third Liberty Loan. 
Q-22. — Establishment of home vegetable gardens. 
Q-24. — Disposal of excreta. Submitting draft of municipal ordinance. 



85 

Q-27.— Requesting a ten-day report of smallpox, varioloid, and varicella. 
Q-29.— Memorandum stating the reports that the district health officers 

shall render to the Central Office. 
Q-43. — Instructions for use of anti-typhoid vaccine. 
Q-44. — Instructions for handling bacillary dysentery cases. 
Q-47.— Requesting periodical submission of samples of milk for' bacterio- 
logical examination. 
Q-48.— Directing that newly born children shall be vaccinated against 

smallpox. 
Q-52.— Transmitting instructions for sanitary maintenance of milk offered 

for sale. 
Q-54. — Campaign for Fourth Liberty Loan. 
Q-58.— Making uniform the annual reports of district health officers, with 

adequate tabulations. 
Q-60. — Amending the regulations governing the uniforms of officers. 
Q-70. — Making compulsory the bacteriological examination for venereal 

diseases of dancing girls. 
Q-72. — Requesting that all laborers collected by the Bureau of Labor be 

physically examined before transferred to other localities. 
Q-73. — Requesting provision for all provinces of the necessary quantity of 

disinfectants and disinfecting pumps. 
Q-74. — Making provision for having equipment for emergency hospitals 

ever ready in the health districts. 
Q-80. — Appointment of employees of the Service as enumerators of the 

Philippine census. 
Q-82. — Designating as clean-up-week the period from December 14 to 21. 
Q-84. — Re making uniform weekly reports. 

II. 
FINANCIAL STATEMENT. 

The appropriation for the health organization was not uniform 
in all the provinces as may be noted in the following Tabulation 
B. Each province appropriated funds for public-health work 
during the year, but only in accordance with their sanitary ne- 
cessities and not for permanent sanitary improvements. 

The amount set aside each year by provinces and municipal- 
ities is not uniform for the reason that the assignment of the 
amount to be contributed to the health fund of the provinces 
is left to the discretion of the municipal councils and the pro- 
vincial boards, in accordance with section 1012 of the Adminis- 
trative Code, provided that said amount be not less than five 
per cent nor more than ten per cent of its general funds. 

For this reason, only the larger financially prosperous prov- 
inces are usually provided with laboratory facilities, free medi- 
cal attendance, and medical inspection of schools; and maintain 
hospitals and district nurses' service. 



86 



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87 

Table B shows the funds appropriated for each of the pro- 
vinces embraced by this division for the public health necessities 
for the year 1918. 

From a study of said table it can be deduced that out of the 
total amount expended by the health organizations in the prov- 
inces 68.31 per cent w^ere expended in salaries; 10.28 per cent 
in traveling expenses; 12.97 per cent for medicine and disin- 
fectants, and the rest v^as used for sanitary activities. 

Comparing the total amount appropriated and the expendi- 
tures w^ith the total population embraced by this division which 
is estimated to be 8,000,000 (see Table C) shows that the aver- 
age annual expenditures per capita of the sum appropriated is 
f^O.12; and ^0.10 if compared with the total amount expended. 
If it is compared with the amount expended for medicines and 
disinfectants, there results an average of ^0.02 per capita for 
this purpose. 

It may, therefore, be safely concluded from the above-men- 
tioned data that the importance of public health work is prac- 
tically neglected in most provinces as only small amounts are 
appropriated for that purpose. 

General consensus of opinion places the expenditures neces- 
sary for satisfactory public health activities in a community 
at about ^0.50 per capita. Of the provinces which appro- 
priated funds for public health work, only one-fourth appro- 
priated amounts that may be considered reasonable for public 
health work in their respective communities. 

Under present conditions the average salary of the sanitary 
personnel is as follows: For the district health officer, ^2,750 
per annum ; for presidents of sanitary division, who are doctors, 
^1,200 per annum; for nurses, ^720 per annum; for sanitary 
inspectors, ^360; and for clerks, ^480. The above empha- 
sizes the fact that health officers are not highly paid as public 
servants. 

The tendency of the division has been to appoint to the posi- 
tion of president of sanitary division doctors who are fully 
qualified on diagnosis and treatment of diseases in the individ- 
ual without requiring, as chief qualification, the competence 
to assume the responsibilities of safeguarding the sanitation 
of a community. 

Hence, the majority of these health officers are busy medical 
practicioners and devote the least possible time to public sani- 
tation. 

Having the prevention and control of communicable diseases 
in mind, the chief duty of the health organization in the selec- 



88 

tion of the health officers should be to choose, not the skillful 
medical graduate, but a trained sanitarian, even though the 
latter may be a nonmedical graduate. 

Also the health officers should serve on a full time basis. 
Poorly paid, untrained, and what is worse, uninterested health 
officers, cannot be expected to establish an efficient record in 
public health work. 

Public health activities in many communities are generally 
neglected and the health organizations in such communities are 
too often inadequate, inefficient and the personnel poorly paid. 
The value of measures necessary for the reduction of sickness 
and deaths from the common preventable diseases seems to be 
but poorly appreciated when municipal and provincial appro- 
priations for the control of the health hazards • are compared 
with those for other necessities. 

It is true that by comparing the total revenues with the total 
expenditures, there is left a balance of ^248,643.82 for the fiscal 
year 1918, but this balance is due to the frequent resignation of 
personnel in the majority of the provinces on account of their 
small salary and to the failure to always find substitutes. The 
balance is, therefore, accumulated at the expense of gained 
salaries. Sometimes this balance is thus purposely accumu- 
lated by the provincial boards for the construction of hospitals 
and other permanent sanitary improvement. 

VITAIi STATISTICS. 

One of the chief points that health organization must consider 
is the scientific study of vital statistics. 

The most important feature of the work of a health officer 
for the preservation of the community is based upon vital 
statistics. 

''Vital statistics,'' said Mr. W. F. Petric, ''and public health 
administration may be termed a business proposition and can 
be tested by the same standards that are used to determine the 
value of other industrial activities." 

Statistics, in brief, is an accounting. The executive, indus- 
trial and financial manager is a requisite needed for the efficient 
administration of his business. A detailed analysis of the cost 
of production and distribution." 

"The health officer of the community has a problem similar 
to that of the business manager in industry, and it is through 
vital statistics that he must test the efficiency of his manage- 
ment." 



89 

For the above quoted reasons great efforts have been made 
by this office towards demanding from the health officers most 
exact and complete possible statistics. 

With accurate vital statistics the v^ork of prevention and 
control of communicable diseases becomes easy, for it renders 
the district health officer able to warn himself of the occurrence 
of any outbreak or epidemic, or the undue prevalence pf a com- 
municable disease. Furthermore, vital statistics will show him 
as well as the public the efficiency of his work shown by re- 
duction of mortality in certain groups of diseases. Also with 
this knowledge he will be able to exercise a general sanitary 
supervision over his district and efforts may thus be made with 
best advantage to improve the public health and reduce the 
death-rate in the locality under his jurisdiction. 

Vital statistics of three consecutive years have been studied 
in this report. 

Table C shows the population, mortality, natality and mar- 
riages by provinces. Thp total population compiled for the 
year 1916 in each province has been obtained by estimating the 
natural increase of population based on the official census for 
1903. The population for 1917 has been calculated by adding 
to the population given for 1916, the difference between births 
and deaths, and the population for 1918 has been estimated in 
the same manner. Therefore, the population considered in each 
province is not exact, only a relative exactitude resulting from 
the arithmetical operations mentioned and really represents the 
population at the beginning of each year. 

Gene7^al statistics. — The following Table C shows marriages, 
births, and deaths as registered in each province during the 
years 1916, 1917, and 1918, giving also the death rate per 1,000 
population. (See Table C, pp. 90-92.) 

By a study of said table, it will be noted that the number 
of marriages has been almost the same during the three years 
mentioned. The same conclusion may be inferred from the 
birth rate for the same period of time, while it is smaller during 
1918 on account of the influenza pandemic which caused quite a 
number of deaths among pregnant women. 

The death rate for 1916 and 1917 is almost the same and 
this is very apparent in view of the fact that the epidemiolo- 
gical conditions prevailing during the said two years were very 
similar as may be elicited from the study of Tables F and G. 

During the year 1918, the death-rate was 15 times more than 
that of 1917 on account of the influenza epidemic, while on the 
other hand the infant mortality in 1917, if compared with that in 



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93 

1916, is quite high and still higher if compared with that of 
1918. This increase in this death-rate is also an indication 
that infants under one year of age have shared the toll of death 
caused by the world ''pandemic/' 

To check the gradual increase of the infant mortality rate, 
as noted from year to year in the Philippines is not merely a 
sanitary but an economic and social problem which, it is be- 
lieved, can be solved only when philanthropical societies are 
organized with the purpose of educating the Filipino mothers, 
especially of the poorer classes, on prenatal hygiene and the 
proper care of infants, the latter comprising a knowledge of 
infant feeding, proper clothing, housing, etc. 

A mere inspection of the various city districts or barrios in 
the provinces would clearly show the truthfulness of the above 
statement. 

Mortality by age groups. — Table D shows the mortality by 
age groups as they occurred in each province during the years 
1916, 1917, and 1918. (See Table D, pp. 94-96.) 

A study of this table will show a high death rate in infants 
from to one year, if compared with the other groups of ages. 
Also the number of persons who died at the age of 100 years or 
over are higher than those registered in foreign nations' mor- 
tality statistics. 

It would not seem safe to point out that the cause in ex- 
plaining the high percentage of deaths of persons of 100 years 
of age or over is due to the diet of the Filipino farmer, because 
in most instances the age of these persons cannot be confirmed 
by lack of personal data, and also the certificate of death of 
the deceased is not, as a rule, available, hence the age is just 
based only on general appearance and some few data furnished 
by the family of the deceased. 

Mortality from to U years, — Table E has been made with a 
view to showing whether the excessive infant mortality rate 
in the Philippines occurs in infants under 1 year of age only 
or in children from 1 year to 4 years inclusively; and also to 
compare this mortality rate with the total mortality rate so 
as to see if the probable cause could be elicited which may be 
considered as the maintenance of the high or excessive infant 
death rate in the Philippines ; but figures of Table E show that 
the mortality rate in the groups of ages from zero to 4 years 
is not undergoing notable changes if it is compared with the 
total mortality, not even in the year 1918 in which an epidemic 
of influenza has been registered. Therefore it may be estab- 
lished that more than one factor is concerned in infant mor- 
tality being so excessive. (See Table E, p. 97.) 



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Mortality by most common diseases, — In the following Table 
F has been grouped the deaths registered during the present 
year by the most common diagnosis made in the provinces. 

Table F. — Summary of the most common causes of mortality occurring 
during the last three years. 





1916 


1917 


1918 


Causes. 


Number. 


Rate 
com- 
pared 
with to- 
tal mor- 
tality. 


Number. 

21, 901 
2,096 
8,825 
8,024 
6,799 

28, 597 


Rate 

com- 
pared 
with to- 
tal mor- 
tality. 


Number. 


Rate 
com- 
pared 
with to- 
tal mor- 
tality. 


Convulsions 


23,206 
1.925 
8,133 
6,858 
6,858 

25, 862 


Per cent. 

12.94 
1.07 
4.53 
3.83 
3.81 

14.42 


Per cent. 

11.23 
1.07 
4.52 
4.11 
3.48 

14.67 


27, 486 
2,638 

11,663 

11, 587 
7,771 

34, 520 


Per cent. 
8.59 


Simple meningitis 


0.82 


Congenital debility _ > __ _ 


3.61 


Beriberi 


3.62 


Diarrhea and entiritis 


2.42 


Malaria 


10.79 






Total 


72, 842 


40.25 


76, 242 


39.82 


95, 665 


30.00 











Convulsions. — While it is true that the term ''convulsions'' 
is accepted as a cause of death by the International nomencla- 
ture, it is nevertheless considered to be a pseudodiagnosis as 
it is usually a terminal symptom of various diseases, especially 
those caused by a septicemia or toxemia, particularly in infants. 

Hence, said disease (?) is considered to be preventable and 
so it is included in that group. 

Considerable effort has been made by this division tov^ards 
the disuse of this diagnosis by the health officers in order that 
in making the real specific diagnosis, the word "convulsions'' 
vv^hich means a symptom and not a specific disease can be 
eliminated from the mortality statistics. The results of these 
efforts are that the proportion of deaths from the so-called 
"infantile convulsions" not certified by a qualified physician 
occurring v^ithin his district has been gradually decreasing as 
follows: 12.94 per cent in 1916; 11.23 per cent in 1917, and 
8.59 per cent in 1918 notwithstanding the influenza pandemic 
which was present during the latter year. 

Simple meningitis. — The same facts as were pointed out when 
discussing "infantile convulsions" can be repeated in regard 
to "simple meningitis," as a great many of the "diagnosis" of 
"meningitis," were only "meningismus," which is in reality a 
common terminal sypmtom in several toxemias and septicemias, 
especially in infants. Fortunately this diagnosis as a cause of 
death is also now decreasing. 

Congenital debility. — A great number of deaths ftom "con- 
genital debility" is registered in the mortality statistics, this 
increase being more apparent if mortality figures of 1916 are 



99 

compared with those of 1918. It is believed that under the 
term of ''congenital debility'' are included many deaths pro- 
duced by accidents of labor and during the puerperal state, and 
also which happened when childbirth caused an acute infectious 
disease of the mother. Hence, it is not rare that deaths regis- 
tered from this cause which in 1916 were 8,133, reached as 
high as 11,663 during the year 1918, due undoubtedly to in- 
fluenza which was severely epidemic in the latter part of the 
year and many pregnant women were suffering from said 
disease. 

It is, however, regretful to state that mortality from the 
aforesaid cause is steadily increasing notwithstanding the fact 
that the health organizations in the provinces are generally 
improving their sanitary personnel, especially the number of 
district nurses. The same remark could also be made in regard 
to the ''infant mortality rate" and mortality from "infantile 
beriberi'' as well. The decrease of the death rate from these 
above-mentioned diseases should be considered as the real gauge 
of the efficiency and activity of the sanitary personnel especially 
the nurses of the province where high death rates are registered 
from these causes. 

Beriberi — It is not possible to obtain definite data relative 
to the number of deaths from beriberi by ages among infants 
and adults, as many of the health districts reported these deaths 
without giving a separate statement as to ages. Nevertheless, 
it may be safe to state that 75 per cent of the deaths registered 
from beriberi occurred among infants. 

Beriberi is a cause of increased mortality, although its pro- 
portion when compared with total mortality is steadily the same. 
High prices of food articles and high cost of living cause the 
poorer class to pay its tribute to this scourge. During the year 
mortality from beriberi increased but it is believed that most 
of these diagnosis were really influenza, but confounded with 
this disease. 

Diarrhea and enteritis. — No comment is made on this cause 
of death because figures remain insensibly unavailable for the 
three comparative years, except that it is a preventable one, 
though the proper selection and handling of food, drinking 
water, proper disposal of excreta as well as the elimination of 
fly breeding places would decrease the number of deaths from 
this disease. 

Malaria, — This is one of the diseases which cause as many 
deaths as tuberculosis in the Philippines and both are respon- 
sible (for more deaths than any serious epidemic that has ever 
appeared in the Islands. 



100 

For the last few years, deaths form malaria have shown pro- 
gressive increase. During 1916, 25,862 deaths were registered; 
28,597 in 1917, and 43,520 in 1918, although the specific mor- 
tality rate of this disease if compared with the total mortality 
is as follows: 1916, 14.42 per cent; 14.67 per cent in 1917, and 
10.79 per cent in 1918. 

Malaria is endemic in almost all provinces of the Archipelago, 
the most severely infected being the Provinces of Ambos Ca- 
marines, Batangas, Cagayan, Cebu, Isabela, Ilocos Norte, Ilocos 
Sur, Laguna, Leyte, Occidental Negros, Oriental Negros, Panga- 
sinan, Palawan, and Tayabas. 

The topographical configuration of the Islands, the prevailing 
seasonal changes and the comparatively small population co- 
vering great extensions of land render the eradication of ma- 
laria rather a difficult problem to solve in spite of the sanitation 
of the poblaciones and barrios and the free distribution of qui- 
nine to the inhabitants. The drainage of the very wide areas 
which constitute mosquito breeding beds cannot be worked out 
due to the lack of funds which such permanent improvements 
will require. Municipal funds are usually short, rendering the 
anti-malaria campaign slow and practically useless. 

Summary. — Of the most common diseases the mortality from 
more or less preventable causes rates 30 per cent of the 
total mortality which is comparatively a low rate if compared 
with that of the years 1916 and 1917, despite the fact that 
during the year 1918 widespread epidemics have visited the 
Islands. This simply means that a little headway was made 
in sanitation in general, as evidenced by the decrease of mor- 
tality from preventable causes. 

Mortality from communicable diseases, — Tables G, G-a, and 
G-& show the number of deaths registered in 1916, 1917, and 
1918, respectively, from dangerous communicable diseases. Of 
these diseases comments will be made relative to the following : 
Dysentery, cholera, measles, typhoid fever and tuberculosis 
which are the most commonly registered in the Philippines,. 
Under separate sections will be discussed ''influenza" and 
''smallpox" which were widely, epidemic throughout the prov- 
inces comprised by this division during the year. 

Dysentery. — A total of 8,973 deaths from dysentery was re- 
ported during the year covered by this report against 7,092 in 
1916 and 7,496 in 1917 with the following specific rate per cent 
compared with the total mortality: 3.09 per cent for 1916; 
3.08 per cent for 1917 ; and 2.99 per cent for 1918, respectively. 
It is, however, remarkable that if the percentage is compared 



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107 

with the total mortality from communicable and preventable 
causes, it is very apparent that the toll of death from this 
disease causes a relatively very low percentage as demonstrated 
by the following: 7.20 per cent against 14.47 per cent for 1916; 
and 16.80 per cent for 1917. 

It is proper to state that in this report all deaths caused by 
mucoid and bloody stools have been compiled together irre- 
spective of their etiological origin for the reason that despite 
the considerable efforts of this office to collect data specifying 
the amoebic from the bacillary form, returns received from the 
health stations in the provinces have failed to clearly state 
these different classes of dysentery. It may be, nevertheless, 
assumed that in nearly 90 per cent of all deaths from dysentery 
in the provinces they are of the bacillary tjrpe. Conditions 
favoring the spread of this disease are chiefly the faulty sani- 
tation of most barrios and poblaciones throughout the prov- 
inces, particularly as regards sewage disposal and drinking 
water, as well as unhygienic habits of the people of eating with 
their fingers and improper handling of food. 

It is hoped that the deaths rate from this disease will grad- 
ually be lowered, when the conditions as pointed out above 
are remedied. 

Measles. — Measles have never been widely epidemic in the 
provinces during the year as only 739 deaths have been reported 
in the provinces comprised in the Division against 683 deaths 
from the same disease in 1916 and 1,098 in 1917. The specific 
deaths rate percentage from this cause during the present year 
as compared with that of the last two mentioned years is as 
follows: 0.23 per cent as compared with 0.38 per cent in 1916 
and 0.56 per cent in 1917. The death rate if compared with 
the total mortality from preventable causes is as follows : 16.07 
per cent in 1916; 2.46 per cent in 1917, and 0.59 per cent for 
this year. From the above figures it may be inferred that 
measles is decreasing each year to the extent that it will prob- 
ably no longer constitute one of the chief causes of mortality 
among the communicable and preventable. 

Typhoid. — During the year, 3,817 deaths from typhoid have 
been reported in various provinces comprised in this Division 
against 2,144 registered in 1916 and 3,733 in 1917, with the 
following specific death-rate as compared with the total mor- 
tality of 1.10 per cent in 1918 ; 1.18 per cent in 1916, and 1.91 
per cent in 1917. 

The percentage of mortality as compared with the total mor- 



108 

tality from communicable and preventable causes is apparently 
showing gradual decrease as may be seen from the following; 
in 1916, 5.20 per cent; in 1917, 8.36 per cent; and in 1918, 3.06 
per cent. 

Tuberculosis, — By the study of Tables G, G-a and G-b it 
be observed that deaths from tuberculosis are increasing from 
year to year and are more than those that occurred from dys- 
entery, cholera and typhoid altogether. The incidence rate 
from tuberculosis is due to many causes, the most important 
ones of which will be treated upon in order to show the meas- 
ures which should be taken against the disease. 

Preconcieved prejudices constitute one of the principal causes 
of the propagation of tuberculosis. The wrong idea that people 
have in regard to isolation and other preventive measures which 
should be taken with a patient who is suffering from tuber- 
culosis makes this disease easily propagated from year to year. 
It is very common in the Philippines to hear that either some 
locality or such a spring are excellent for the cure of tubercu- 
losis. As a general rule, these places or sanatoria which may 
be called rural sanatoria established by popular belief, are 
usually located in places where there are no accommodation 
facilities. The patient usually boards in a house located in 
such a place, paying a moderate rate to the owner of the house. 
As commonly happens, the people in such cases have hardly 
anything in the way of kitchen utensils, and other utensils to 
be exclusively used by the patient, and the result is that the same 
utensils used by the tuberculous person are also used and handled 
by the rest of the family living with him. No precautions 
against the disease are taken by him or by his housemates, 
and if he does not succumb to the disease, the length of the 
time of his stay in the house becomes unendurable to him and 
compels him to abandon the house to look for another place where 
he is surely going to spread the disease, after having contam- 
inated one or more individuals of the family with which he 
was living. The overcrowding on account of the high cost 
of rental of dwelling houses is another of the chief causes of 
the propagation of the disease. So long as there is a place 
for a bamboo bed (lancape), large enough for a family to live 
in, it is regarded as fit for their residence. 

It is a common sight to see a whole family with several 
children sleeping on one bamboo bed. There are small ''shacks'' 
in which not only the purifying rays of the sun but even the 
diffused day-light do not penetrate, surrounded by dumps and 
filthy places which are the most suitable locations for the prop- 
agation of tuberculosis micro-organisms. 



109 

A visit to these filthy ''shacks" will disclose the stigma of 
this terrible disease upon the faces of the small children. 
Oftentimes when making house-visits and whenever the isola- 
tion of the tuberculous child is strongly recommended to the 
parents so as to prevent it from infecting the others, their 
answer would be : ''Oh, doctor ! you are giving us an impractic- 
able advice as this small room is all that we possess to sleep in/' 
So the sick child must sleep with the others. And in some of 
these "shacks'' there are from five to seven children. 

Another important factor in the propagation of the disease 
is the ignorance of the great majority of the lower classes of 
people, which at times constitutes rather a real prejudice. 

Considering the above-mentioned factors with reference to 
the propagation of this disease, and some others that may be 
mentioned, an effective antituberculosis campaign should cover 
the following point : 

First. Early detection of cases and a study of the problems 
involved in the control of the disease. 

(a) Report and registration of all cases found (tuberculosis 
census), (6)i home visits, (c) facilities for an early diagnosis 
of cases, (d) antituberculosis education. 

Second. Proper care of knoivn cases which compriseSy viz: (a) 
medical attendance, (&) social welfare. 

Third. Segregation in Government controlled colonies. 

Fourth. A more rigid enforcement of the building ordinances 
in the croivded centers, to the end that each and every habita- 
tion will have sufficient space around it to permit the free 
entrance of sunlight and circulation of air. 

Fifth. An educational campaign, to do away with the present 
custom of keeping windows closed, day and night. 

In order to prevent tuberculosis, education must begin in 
childhood as this is the only way of preventing all sorts of 
prejudices, social troubles and evils which oftentimes are res- 
ponsible for the appearance of tuberculosis. 

The purpose of the tuberculosis census is simply to have 
accurate information as to the actual extension and distribu- 
tion of tuberculosis in the Philippines. 

House visits to patients are of urgent necessity at least in 
those cases where patients cannot afford the attendance of a 
doctor, this being the only way to study all factors related to 
every particular case. 

An early diagnosis of tuberculosis will not only permit the 
treatment of a case with better results, but also will prevent 



110 



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112 

the contacts from becoming contaminated, hence the necessity 
for numerous facilities for diagnosis. 

Medical attendance may be facilitated by the establishment of 
charitable institutions, such as free dispensaries, etc., and so- 
cial welfare may be achieved by promoting the use of a balanced 
diet, sanitary houses, and proper occupations, etc. 

EPIDEMICS. 

Cholera. — (See Table H.) Out of the thirty-five provinces 
comprised in this division, only fifteen have been registering 
cases of cholera with persistence as may be elicited from the 
following table. 

It may, nevertheless, be assumed that during this year cholera 
has never been seriously epidemic, as the cases reported were 
isolated or sporadic, constituting small outbreaks which were 
easily controlled. The Province of Bohol has been the worst 
infected, the incidence in this province being 4.10 per thousand 
population, which is rather too low an incidence to constitute an 
epidemic. The percentage of mortality has not suffered any 
changes during this year, if compared with the percentage re- 
gistered by this disease during past years. This high percent- 
age is due to the fact that the people do not call for a physician 
during the early stage of the disease, because, as will be seen 
by the analysis of the above-mentioned table, the cases that were 
hospitalized have a lower percentage of mortality, this percent- 
age being only 58.44 per cent as against 73.52 per cent which is 
the percentage among outside cases, notwithstanding the fact that 
most of these cases have been hospitalized during the precarious 
stage of the disease. The measures taken for the control of 
these small outbreaks of cholera were simply the proper observ- 
ance of the rules and regulations prescribed by the Central Office 
which may be found in previous annual reports of this Service 
and by the establishment of provisional emergency hospitals 
where all cases were isolated. In so far as the incidence is con- 
cerned, it may be safely assumed that the occurrence of more or 
less serious outbreaks of cholera in the provinces shall always 
be registered inasmuch as proper sewage disposal is not general- 
ized throughout the Islands. 

Smallpox, — (See Table H-a.) 

The first case of smallpox in the provinces comprised within 
this division, occurred in the month of February in the Province 
of Rizal. During the month of March, the Provinces of Bataan, 
Bulacan, Cavite, Laguna, Nueva Ecija, Pampanga, Pangasinan 



113 



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115 

and Tayabas were also invaded by the disease. During April 
Batangas, Ilocos Norte and Ilocos Sur reported cases. During 
May the Provinces of Mindoro, Nueva Vizcaya, Romblon and 
Zambales were invaded, and in June the Provinces of Antique, 
Cebu, Capiz and Bohol, and since August it may be said that 
the epidemic of smallpox was present in practically all the 
Provinces of the Archipelago. The original source of the epi- 
demic was formed in the city of Manila, and from this city 
as a center,- it invaded the provinces surrounding the city by 
concentric circles, thus visiting the provinces of Central Luzon 
and later spreading towards the north and south of the Archi- 
pelago. 

Thirty-three thousand eighty-nine cases with 14,092 deaths 
were the toll which the population comprised within this division 
has paid to the epidemic, resulting in an incidence of 4.15 per 
thousand, the Province of Rizal being the one contributing the 
largest share to the epidemic with 38.56 per thousand of in- 
cidence. The general average of mortality from smallpox has 
been 41.60 per cent among unhospitalized cases and 38 per cent 
among hospitalized, the Province of Rizal also recording the high- 
est mortality, 67.24 per cent. 

It has not been possible to secure statistics of cases by ages, not 
even a fairly accurate one; but it may be assumed, basing our 
assumption upon the personal inspections made by this division, 
that about 75 per cent of all cases registered were children under 
nine years of age. 

The cause to which the appearance of the epidemic of small- 
pox during this year may be attributed is that the extreme con- 
fidence, on the part of the sanitary personnel, in the immunity 
rendered by the systematic and general vaccination ending in 
the year 1910, which apparently led it to abandon the scientific 
vaccination that they should have carried out during the follow- 
ing years ; and also to the fact that the parents of children also 
shared equally in this confidence to the extent that they practi- 
cally encouraged the hiding of their children from the vac- 
cinators whenever they requested the parents to have their 
children vaccinated. This wrong belief was undoubtedly due 
to the extreme confidence that they had in the assumption 
that the Archipelago was entirely free from smallpox. This 
fact is proved by the inspection of the school children dur- 
ing the epidemic, which showed that no cases of smallpox had 
been registered among them on account of the yearly vaccinations 
of school children which had been strictly enforced by the school 
authorities. 



116 

Both virulent and mild smallpox types of the disease have 
been present during the epidemic. All cases of hemorrhagic type 
were fatal. Mild cases occurred among those unvaccinated and 
sometimes among those v^ith vaccination scars, but in the latter 
the form was generally discrete smallpox or mild varioloid. 

Short incubation periods have been registered in some cases. 
In the municipality of Binangonan, Province of Rizal, and in the 
municipality of Dingras, Ilocos Norte, and in Bacoor, Cavite, 
children five days old living in contact with smallpox cases have 
died from confluent smallpox, not having contracted it from their 
mothers either during pregnancy or post partum. But the short- 
est incubation period outside of these special cases is given as 
ten days. 

The method of infection most generally recognized was by 
contact infection, by carriers and by living in infected houses. 

The unhygienic conditions of the rural people, the promis- 
cuous visiting, the concealment of cases, the delayed reporting, 
and the moving of persons suffering from smallpox from town 
to town were the principal factors in spreading the disease. 

The measures taken to control smallpox were the maintenance 
of the houses infected under quarantine or the establishment of 
emergency hospitals or isolation camps for the patients, a 
compulsory intensive and extensive vaccination and the disinfec- 
tion of promises and fomites. 

Influenza, — (See Table H-c.) 

The influenza epidemic, though not recognized as such at 
first, made its appearance in the Islands between the middle 
of April and the first week of May, because an increase was 
noted about this time in the number of deaths from respiratory 
diseases with a duration of but from five to twelve days, but 
which were diagnosed, however, as pneumonia, broncho-pneu- 
monia, pulmonary tuberculosis, and even as typhoid fever, beri- 
beri and malaria. 

The epidemic was clearly and frankly recognized, though, 
as such toward the last week of June and thoroughout July 
in the provinces near Manila, affecting more than 40 per cent 
of the population, but attended with very slight mortality, if 
any. The recrudescence of the epidemic during October proved 
of a more serious character, greater mortality having been 
noted in this instance. 

It is impossible to determine exactly just where the disease 
gained entrance but a study of the schedule of the movements 
of boats in Philippine ports leads to the belief that the epidemic 
was of autochthonous origin, and that the causative microor- 



117 



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COOOUOtON 

r-IOOJOOCO 
T-ICOCOOO 



•(NOOOiCJOC^OT}<m,-HU5 

•Ot-OrHrHCOOOOt-OOS 

■ -h,Ht}<.-(t-(CO«OOCJCO 



'" Z" 



118 

ganism acquired virulence through repeated and rapid passage 
from individuals to individuals in a year when the increased 
volume of traffic and business in the whole country brought 
about continuous coming and going of vast numbers of people 
from one point to another, and likewise through the importa- 
tion of other strains of microorganisms of similar nature which 
increased the virulence of the native strains upon meeting on 
common ground. Such is also the case with regard to the course 
taken by the epidemic since October as may be seen in Table 
H-c. From this table it may be seen that the disease spread 
along the highways of commerce and traffic, invading first the 
provinces of easier access and those of poor transportation 
facilities last. 

The epidemic in the provinces should be viewed in the light 
of two phases rather than two distinct outbreaks, the first oc- 
curring during the months of May and June in the Provinces 
of Bataan, Bulacan, Batangas, Rizal, Laguna, Tayabas, Pam- 
panga, and Nueva Ecija, and the second breaking out in October, 
leaving no locality, town or hamlet unscathed, no matter how 
far or isolated. The incidence of cases during the first phase 
was great but was attended with very slight mortality; that 
of the second was characterized, however, with a larger mor- 
tality percentage. 

The disease showed a preference for the age groups between 
10 and 29 years and it is amongst these groups of patients where 
the greatest degree of mortality was encountered. It was im- 
possible to secure the exact number of cases. Notwithstanding 
the popular conception which gives an incidence rate of 80 
per cent for the total population, the perusal of mortality sta- 
tistics in several provinces tends to show that only 45 per cent 
of the population of the provinces under this division suffered 
from influenza with a mortality rate of from 2.50 to 3 per cent. 
Most of the deaths were caused by respiratory, cardiac and 
renal complications. 

The epidemic spread in accordance with the immutable laws 
that govern epidemics, especially those of respiratory infection. 
The disease was propagated not only through direct contact with 
the sick but also through the medium of ambulant cases and 
carriers. It is possible that dust had also something to do 
with the diffusion of the malady for despite the fact that the 
specific cause of influenza has little resistance to desiccation, 
the epidemic during October, November and December spread 
so rapidly as to preclude the possibility of the sick or carriers 
passing the disease to others through contact. 



119 

The district health officers in provinces affected by the epi- 
demic agree on one point: That a previous attack during the 
epidemic in May and June conferred immunity against the 
epidemic later in the year. 

The measures taken against the epidemic were of the same 
nature as those taken in other countries, such as; instruction 
to the public regarding personal prophylaxis; measures for 
collective prophylaxis ; treatment of the sick at their homes and 
in hospitals. Hov^ever, the fact that a great many of the medical 
officers and subordinate personnel of the health service became 
sick themselves made the lack of physicians and nurses more 
acutely felt. Schools and places of amusement were closed in 
certain provinces, but as to the efficacy of these measures con- 
clusions may be drawn from what the district health officer of 
Tayabas has to say in the premises : 

Notwithstanding the fact that the first cases were hospitalized and placed 
under the direct supervision of the health service, the diffusion of the 
epidemic was so rapid and astonishing that in less than one week it had 
extended to all the towns comprised within the district . . . The results 
obtained failed to meet the expectations of the measures taken, viz: isolation 
of the sick whenever possible; disinfection of infected premises; contacts 
and sputum of the sick; hospitalization, popular lectures, and direct in- 
struction to the people to escape infection; distribution of pamphlets in 
Spanish and in the local dialect, etc. The malady followed its own course 
and maintained throughout the epidemic high diffusibility and extreme 
infectiousness. 

Many other statements to this effect could be transcribed 
for the sake of argument. But from the above, the fact is 
established that the measures indicated for this class of ep- 
idemics did not generally give the expected results due to the 
extreme diffusibility of the epidemic. It simply died out when 
fresh victims were no longer available. 

Criticisms of the most virulent character were launched 
against the Philippine Health Service apropos of the epidemic, 
but the measures taken, as a whole, by the Service to combat 
the malady . corresponded with those taken in other countries. 
The trouble was that the Service had to face a disease with 
which it was almost impossible to fight from an epidemiological 
standpoint. The apparent shortcomings should have been viewed 
with a little charity, and the officials and organizations en- 
trusted to look after the public health not held resposible for 
biologic phenomena which they were powerless to stop. 

The following is a summary of the conclusions drawn with 
regard to the last influenza epidemic : 

First. The epidemic that raged from May to July was the 
grippe, also so-called influenza or trancazo. 



120 



Second. The disease had a preference for the age groups be- 
tween 10 and 29 years. 

Third. The epidemic of October was merely a recrudescence 
and a continuation of the May to June epidemic. 

Fourth. An attack of influenza during the first period of the 
epidemic conferred immunity against another attack of the 
second. 

Fifth. The epidemic was of autochthonous origin, but the 
importation of foreign strains increased the virulence of the 
native strains. 

Sixth. Maritime and land quarantines, hospitalization and the 
closing of schools and places of amusement failed to cut the 
diflTusion of the epidemic short. 

MORTALITY FROM COMMUNICABLE DISEASES. 

The following table shows the total number of deaths re- 
ported during the last three years from all communicable dis- 
eases and the percentage as compared with the total deaths. 



Total 
deaths. 



Deaths ' Percent- 

I commu- ,„Y+u ^-l,^ 
u^^ with the 
: nicable 4.„<.„i^^^ 
^ • ^^ ^r, total mor- 
diseases. 



1916 
1917 
1918 



180,986 40,574 
191,459 I 44,750 
318,784 I 130,028 



tality. 

Per cent. 

22 Al 

! 23.29 

I 40. 93 



In discussing this matter, it should be taken into considera- 
tion that the majority of the most common diseases considered, 
and especially the communicable diseases, are preventable, and 
should a better understanding of their prophylaxis be learned 
and followed by the people, the deaths from these diseases could 
be reduced to a minimum. 

The number of deaths caused by the most common diseases 
plus the number of deaths caused by communicable diseases 
constitute 62.66 per cent of the total mortality for the year 
1916; 63.11 per cent for 1917, and 70.64 per cent for 1918. 
As can be seen, 65 per cent of the total deaths of the population 
of this Division are easily preventable. Taking this fact into 
consideration, the general mortality of this division could pos- 
sibly be reduced to only 20 or 25 per thousand. This result 
can be obtained only through the open and loyal cooperation of 
the provincial and municipal authorities and especially of the 
people in complying with the sanitary rules and regulations^ 
recommended by the health officers. 



121 
IV. 

RxlBIES. 

Table I. — Rabies. 



Provinces. 



Albay 

Ambos Camarines- 

Antique 

Bataan 

Bulacan 

Batan^as 

Bohoi 

Cavite 

Cagayan 



Cebu . 

Capiz 

Iloilo 

Ilocos Norte . 
Ilocos Sur --- 
La Union 



Leyte.. 

Laguna 

Mindoro 

Misamis 

Mountain Province . 

Nueva Ecija 

Nueva Vizcaya 

Occidental Negros . 

Oriental Negros 

Palawan 

Pannpanga 

Pangasinan 

Rizal 

Romblon ^- 

Samar 

Sorsogon 

Tarlac 

Tayabas 

Zambales 

Isabela 

Batanes 



Total . 



Number 


Number I 


of 


of 




persons 


persons 1 


bitten. 


died 




10 




4 


13 




13 


2 















5 




3 










2 




2 


1 




1 


4 




1 


3 







3 







54 




2 


11 




2 


























2 




2 


















1 




1 


8 




2 


5 







1 




1 


10 




1 










7 




1 


41 




15 


6 




3 










1 







5 




5 


19 




5 


13, 







5 







2 




1 











Serum 
adminis- 
tered. 



Complete 

treat- 
ment No. 
6 
3 
2 

4 



2 
3 
3 

9 



2 



6 
4 



3 
18 
6 


a 



& 

13 
5 

1 




65 



82 



Rabies persists in many provinces of this division. In 1918 
a total of 214 persons were bitten by real or suspected rabid dogs, 
65 having died of hydrophobia. Eighty-two persons were treated 
with antirabic serum. The lack of cooperation on the part of 
municipal councils in enforcing the regulations issued by the 
Central Office in accordance with Act No. 2461 regarding the 
muzzling and keeping of dogs and other animals liable to convey 
infection, makes it impossible to completely eradicate rabies in 
the Islands. 

Over 25,000 dogs were killed last year by poisoning, but it was 
impossible to continue killing dogs at this rate during the present 
year due to the strong opposition of the municipal authorities 
resulting from the complaints presented by owners of dogs. 

In view of the above-mentioned opposition, antirabic serum 
was furnished extensively to the sanitary personnel in order to 
systematically use it on any person bitten by any stray dog. 



122 



V. 

VACCINiVTIOX. 

Table J. — Tabulation showing vaccination work performed in the provinces 
during the year 1918. 



Provinces. 



Albay 

Ambos Camarines ._ 

Antique 

Bataan 

Batanes 

Batangas 

Bohol 

Bulacan 

Cagayan 

Capiz 

Cavite 

Cebu 

Ilocoa Norte 

Ilocos Sur 

Iloilo 

Isabela 

Laguna 

Leyte 

Mindoro 

Mountain Province . 

NuevaEcija 

Nueva Vizcaya 

Occidental Negros __ 

Oriental Negro3 

Palawan 

Pampanga 

Pangasinan 

Rizal 

Romblon 

Samar 

Sorsogon 

Tarlac 

Tayabas 

Union 

Zambales 



Total- 



Units 
issued. 



90, 500 

73, 660 

10, 960 

52,000 

5,000 

291, 740 

15, 000 

153, 800 

50, 440 

8,200 

130,400 

746, 100 

141, 360 

80, 770 

258, 980 

25, 980 

301, 800 

175, 000 

46. 920 

51, 980 

112, 000 

12, 960 

11,000 

2,000 

8,500 

269, 910 

239, 600 

353, 870 

50, 780 

45, 080 

56,000 

41, 920 

244, 160 

72,010 

115, 450 



4,318,830 



Total vac- 
cinations. 



64, 749 
71,713 
23, 097 
48,322 
5,693 

170, 630 
75. 095 

123,284 
46, 235 
17. 507 
81, 171 

349,331 
86, 319 
70, 739 

166, 562 
9,366 

323, 912 

168.447 
29. 638 
21,397 
67. 636 
15, 142 
48, 887 
15, 518 
6,512 

299, 685 

215, 997 

237,652 
14, 788 
24, 526 
34,971 
35, 163 

195, 939 
62, 102 
57, 691 



3,285,376 



Total ins- 
pections. 

51,041 

57, 863 

22, 015 

31, 872 

2,116 

76,692 

67, 664 

72, 162 

37. 920 

16,088 

72, 338 

294, 288 

77.224 

64. 036 

79, 308 

8.749 

211,343 

102, 513 

21, 328 

16.318 

54, 470 

14, 573 

43, 748 

14, 948 

3.741 

208,726 

192, 617 

185, 272 

9,469 

13,776 

23,373 

33, 428 

146, 704 

51, 058 

46, 938 



Positives. 



2. 425, 725 



36, 211 

37,744 

13. 187 

15. 755 

2,002 

49. 898 

39, 075 

49, 015 

23. 193 

11,215 

43. 131 

184, 328 

39, 656 

36, 942 

69, 295 

2,417 

136.036 

50. 102 

18.474 

7,209 

35, 733 

10, 444 

25, 462 

9,722 

2,337 

135, 715 

132. 114 

117,249 

5,439 

8,397 

14,383 

21,471 

99, 998 

26, 649 

28, 118 



I Rate per 



70.94 
65.23 
59.89 
49.43 
99.33 
68.87 
57.75 
67.92 
61.16 
69.71 
59.62 
62.80 
51.35 
57.68 
67.59 
27.62 
64.36 
63.17 
63.17 
44.17 
65.60 
71.66 
58.20 
65.04 
62.48 
60.22 
68.58 
63.28 
39.62 
60.95 
6.112 
64.20 
68.09 
51.99 
59.90 



1, 533, 595 



63.22 



Four million three hundred eighteen thousand eight hundred 
thirty units of vaccine virus were furnished throughout the prov- 
inces comprising this division with which 3,285,376 persons were 
vaccinated. Two millon four hundred twenty-five thousand 
seven hundred twenty-five persons were inspected and 1,533,595 
were found positive. 

From these figures it may be seen that during the year 1918, 
47.74 per cent of the total population of the area covered by this 
report were vaccinated ; 63.22 per cent of the people vaccinated 
were inspected and 25 per cent of those inspected showed positive 
results, and as many of the persons not inspected might also have 
resulted positive, it can therefore be deduced that 38.5 per cent 
were made immune against smallpox. 

This work is performed by the sanitary personnel of the health 
organization assisted by about 225 additional temporary vac- 
cinators appointed as soon as the first cases of smallpox appeared 
in the provinces. 



123 

As soon as the first cases of smallpox were reported, Circulars 
Q-14, Q-17, and later Q-48 were issued ordering an extensive 
and intensive vaccination among all the people, especially among 
those children from to 10 years of age, not school children, 
attending at the same time to the revaccination of the rest of 
the people in every barrio. 

Many babies suffering from smallpox were concealed and not 
discovered until the disease was well advanced. In some places 
the parents objected to vaccination of their children, so that it 
became necessary to call the assistance of the police. Eliminat- 
ing this little friction among the people of the barrios, practically, 
vaccination could be performed easily. 

VI. 



LABORATORIES. 



The work done by provincial laboratories appears in the fol- 
lowing table. 

Table K. — Laboratory work — Specimens examined during the year 1918. 



Provinces. 


Blood. 


Urines. 
23 


Nasal 
secre- 
tions. 

4 


Spu- 
tum. 


Faces. 


Vagi- 
nal 
secre- 
tions. 


Pus. 


Total. 


Ambos Camarines 


30 


43 


31 






131 


Albay 








Antique 


















Bataan 


















Bulacan . 


6 


46 
6 


12" 


6 
29 


285 
209 


134 
52 





477 


Batangras 


368 


673 


Bohol _. .. .. 






Cavite 










1 






Cagayan 










.. 1 - 






Cebu 


330 


96 


3 


3 


13, 645 






14, 077 


Capiz 








Iloilo 










160 






160 


Ilocos Norte . .. _ 
















Ilocos Sur 


405 
(a) 
54 


32 

(a) 
93 
800 
68 
32 
22 

(a) 
31 


9 

"s' 

1 


11 

7 
5 
3 

20 
3 

7 


402 

5 

800 

12 

104 

3 

25 






859 


La Union 


""468' 


16 




Leyte . ._ 


175 


Laguna 

Mindoro 

Mountain Province 

Nueva Ecija 


800 
16 
30 

7 

(a) 

4 


2,873 
107 


4 
86 

6 


1 


192 
121 


Nueva Vizcaya 

Occidental Negros .- 


73 


Oriental Negros 


(a) 


(a) 




Palawan 




Pampanga .. 


2 

42 
(a) 
(a) 


377 , 


3 
5 


7 
15 






389 


Pangasinan 

Rizal 


42 
(a) 

(a) 






16 


120 


Romblon-. 




Samar . ^ - 




Sorsogon 


(a) 

(a) 

386 
33 


(a) 
(a) 
420 

34 


311 
6 


384 
14 


390 
17 








Tarlac 




Tayabas - 


1,899 








104 


Zambales 






















Total .- 


2,513 


2,122 


354 


540 


16. 118 


750 


33 


22, 430 









a No laboratory. 



124 

No province established laboratories during the year because 
microscopes were unobtainable either in the United States or in 
the local market. 

No record is available of the work performed by the provincial 
laboratories during the year 1917, but it may be assumed that 
the work performed during the present year exceeded that 
performed during the last year on account of the examination 
of the 15,000 enlisted men in the Philippine National Guards 
federalized in the month of October. 

VII. 
medicatj relief. 

One hundred sixty-five more (see following Table L) new free 
public dispensaries were established during the year, making a 
total of 562 in operation at the end of the present year. 

More than 100,000 patients were attended during the past 
year, and up to the present 241,385 adults and 142,127 children 
have enjoyed the benefits of these dispensaries. 

The establishment of free dispensaries has acted as an im- 
pulsive force in the sanitary work. On more than one occasion 
the knowledge of the presence of dangerous communicable 
disease was obtained through a consultation received in the 
dispensary, and in all cases, surely though slowly, the people are, 
little by little, thought to understand and seek medical relief^ 
and the confidence that has sprung up between the doctor and 
the people from such association has resulted in sanitary im- 
provement. 

VIII. 

INFANT WELFARE. 

The following Table M shows the total number of women's 
clubs, puericultural centers and other institutions scattered 
throughout the provinces comprising this division whose mission 
for the salvation of the lives of children is a most commendable 
one. 

All the institutions mentioned in the attached table have been 
organized with a view to reducing infant mortality. More than 
3,000 memberships constitute the institutions organized, but 
due to the fact that the principal work done during the year 
by each of these societies was the transaction of their incor- 
poration and organization, it is not possible to establish conclu- 
sions in the present year with regard to their efficiency. 



125 



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126 



Table M. — Infant welfare. 



Provinces. 


Women's 
clubs. 


Puericul- 

tural 
centers. 


Mater- 
nity 
wards. 

Number. 


Gotas de 
Leche. 

Number. 


Free dis- 
pensa- 
ries. 


Baby 
contests 
celebrat- 
ed. 


Number 
of pue- 
ricultural 
centers 
submit- 
ting re- 
ports as 
per by 
laws. 


Albay 


Number. 
5 
6 
1 
2 
4 
23 
15 
1 
6 
7 
17 


Number. 


Number. 




Ambos Camarines 












Antique- . 


1 


o" 


5- 


ij 




1 


Bataan ._ 






Batanes _j 








1 




Bulacan _ 


23 


1 




r 




2 


Bohol . 








Cavite 






1 
3 
4 

31 

1 
3 






Batangas .. . 













Cagayan 








5 
6 




Cebu 


1 
1 


1 


1 




Capiz - 




Iloilo 


7 


7 




2 


--|-_----__-^ 


Ilocos Norte. .. .. 




! 




Ilocos Sur 


3 

4 
1 
4 


' 


1 1 


La Union 


1 
2 
2 
2 








. 


Leyte- . 










Laguna 




2 

2 


2 

'" 5' 

4 


^ 


Mindoro 


1 


Mountain Province 


i 

6 

5 

21 


.. 


1 


Nueva Ecija . 


6 




2 


i 1 


Nueva Vizcaya 








Occidental N egros 


3 






1 


2 


1 


Oriental Negros 








Palawan L 








1 




Pampanga . . 


4 
47 
9 
1 
4 
4 
8 
6 
3 
2 








1 




Pangasinan 


2 
2 






34 
2 


8 
8 




Rizal 




2 


2 


Romblon,. . 






Samar 


2 




1 


3 






Sorsogon . 




1 
2 
1 




Tarlac 










1 


Tayabas., 


9 






6 


9 


Isabela . . 








Zambales 








13 


I 












19 


Total 


233 


64 


6 


12 


115 


38 



It is hoped that for the coming year all these institutions will 
be able to start their work under the technical direction of the 
health officers and direct all their efforts toward the protection 
of infants and a reduction of infant mortality by establishing 
special infant dispensaries assisted by nurses and by instructing 
mothers in regard to the care and feeding of infants, etc. 

It is needless to state again that infant mortality is one of the 
biggest problems in the Philippines and that this problem is 
not only purely sanitary, but also economic and social. 

The average annual infant mortality under one year of age 
in the provinces comprising this division is practically one- 
third of the total mortality, and if the ages of from to 4 years 
are considered, it is more than one-half of the total mortality, 
and this is true in every town. The problem can only be solved 
to a great extent by making campaigns and giving instructions 
to the girls attending school, women ii;i factories, etc., with 



127 

regard to the care and feeding of infants, protection of preg- 
nant women before and during delivery, sanitation in the 
houses, etc. 

In connection with the work done by women's clubs and other 
institutions in reducing infant mortality, the district nurses, 
welfare inspectors, midwives and other similar sanitary em- 
ployees also do routine work consisting of public lectures in the 
barrios and personal instruction to mothers and unlicensed 
midwives, making domiciliary visits, giving instructions dealing 
with the principal lines of hygiene and care of infants and 
instructions to unlicensed midwives (intrusas) regarding the 
aseptic method in caring for a delivery case, compelling each 
one of them (midwives) to carry the necessary materials asep- 
ticed for attending a partum. 

Work done by the nurses during the present year. — The fol- 
lowing tabulation shows the work done by the district nurses 
and midwives during the present year. 



Table 0.— District 


nurses's activities 


during the 


year 


1918. 


Provinces. 


Abor- 
tions. 


Normal 
deliv- 
eries. 

33 


Dysto- 
cias. 

3 


Post 
part- 
ums. 

7 


Infants attend- 
ed under two 
years feeding. 


Lectures. . 




Breast. 


Artifi- 
cial. 


Public. 


Pri- 
vate. 


Albay .._ 


13 


62 


152 


Ambos Camarines - ... 








Antique ._ 


8 


20 










10 


50 


Bataan 












Batanes ._ 


















Bulacan _ ._ 


57 


144 


33 


44 


504 


153 


71 


1,572 


Batangas.-- .. -.. -_. 




Bohol 




20 


1 


1 


6 


9 


141 


15 


Cavite 






Cagayan 


















Cebu 


4 
10 
20 


668 
18 
29 


io 

5 
4 


15 

24 

7 


618 
14 
49 


50 

5 

31 






Capiz 


64 
66 


176 


Iloilo 


74 


Ilocos Norte 




Ilocos Sur 






6 


1 










Isabela 














La Union . 


















Leyte 




_ 














Laguna 


1 


4 1 2 
18 j 1 
45 11 


3 
54 

3 

20 

__ 

3 


185 
127 
36 
165 
5 
240 


56 
95 
32 
10 
2 
100 


3 

~""m 

34' 
18 


100 


Mindoro . _ _. 


242 


Mountain Province . 


4 
1 
2 
16 


518 


NuevaEcija 


7 
6 
51 


8 


400 


Nueva Vizcaya 


32 


Occidental Negros 

Oriental Negros -_ -_. 


385 


Palawan . . 


















Pampanga _ 


5 
2 


36 
92 






278 
1,706 


18 


2 
521 


90 


Pangasinan 


9 




5.223 


Rizal 




Romblon 


















Samar _ 


















Sorsogon . 


















Tarlac 










3 
1,244 


4 

72 


14 
35 


40 


Tayabas... 


81 


1,648 


67 


551 


220 


Zambales 






















Total 


224 


2,845 


57 


732 


5,130 


637 


1,158 


9,289 







128 



The public lectures mentioned in Table were given to the 
people in barrios and other distant places. Private lectures 
were given in house to house visits to pregnant women or 
mothers with feeding infants. 

Table N shows the mortality registered by puerperal state 
as compared with the work done by the nurses and midwives. 

Table N. — Mortality by puerperal state. 



Provinces, 


1916 

131 

128 
44 
24 
4 
93 

139 
97 
78 
43 

152 
67 

173 
55 
54 
14 
33 

179 
86 
18 
12 
63 
15 

156 

59 

8 

119 

206 
62 
25 
97 
73 
48 

106 
24 


1917 

140 

128 
42 
20 
1 
72 

147 

131 
51 
39 

212 
83 

167 
58 
50 
19 
46 

265 

1 

14 
69 
19 

185 
85 
12 
84 

158 
60 
26 

117 
98 
79 

115 
19 


1918 


Albay . . 


190 


Ambos Camarines .__ 


187 


Antique . _ 


39 


Bataan 


28 


Batanes ._ _ _ 





Bulacan .. .. 


130 


Batangas 


277 


Bohol _. .._ . . _ _ 


133 


Cavite 


79 


Cagayan 


59 


Cebu 


354 


Capiz 


128 


Iloilo . 


226 


Ilocos Norte . 


72 


llocos Sur.- .... 


79 


Isabela 


32 


La Union .... . . 


35 


Leyte . . . 


310 


Laguna.. . . 


106 


Mindoro.. 


14 


Mountain Province ... .. ... 


16 


Nueva Ecija ... .. 


103 


Nueva Vizcaya . . 


12 


Occidental Negros... ... .. 


167 


Oriental Negros _ . . .. . 


53 


Palawan 


12 


Pampanga _ 


162 


Pangasinan .. ._ ... . 


254 


Rizal ... .. 


65 


Romblon ._ 


42 


Samar . ' j.. 


96 


Sorsogon . 


134 


Tarlac _.. . 


101 


Tayabas _ 


135 


Zambales __ _ . . . _ ._ . 


12 






Total 


2.685 


2.880 


3.842 



It appears that an increase in mortality by puerperal state 
is inversely related to the greater number of nurses and mid- 
wives appointed in 1918 than in 1917 and than in 1916, but 
the increase in 1918 oyer 1917 of the mortality by mentioned 
cause was due to the influenza epidemic and the increase in the 
year 1917 over 1916 is not so notable that it may constitute a 
contraposition to the efficiency of the work done by the nurses 
and midwives, because in the year 1917 the work of the nurses 
was only begun and the people were not too confident of the 
instructions given. 

IX. 

MEDICAL INSPECTION OF SCHOOLS. 

The following Table P has been prepared to show the results 
of medical inspection of schools and pupils. 



129 

Table P. — Medical inspection of schools. 





Number 
of schools 

in- 
spected. 

117 


Number j Number 


Number 
of pupils 
not in- 
spected. 

1,614 


Disp 

Antipolo 
system. 

87 


osal of excreta. 


Provinces, 


of pupils 

in- 
spected. 

14, 539 


or scnoois 
not in- 
spected. 

13 


Septic 
tank. 


Pail 
system. 


Albay _ 


21 


Am bos Camarines 






Antique - 


31 


1,416 


30 


7,333 


8 












Batanes 


10 
82 
93 
29 
4 
6 


1,120 
7,186 
13, 995 
4.093 
175 
1,300 












Bohol 


135 
41 
122 


12,653 
2,819 
13,361 

78 


46 
82 

1 


2 




Bulacan 




Batang'as 


23 


Cavite 


4 


Casrayan 




1 




Cebu __ 












Capiz 


48 

167 

8 

90 

17 

60 

105 

6 


9,690 
13, 686 
2,748 
8.611 
3,575 
9.724 
12,613 
3.757 


80 
62 
25 
23 
50 
4 
56 


12,249 
4, 059 
2,566 
4, 543 
5,287 
2,142 
5,260 
15 


92 
2 


15 
29 


61 


lloilo 

Ilocos Norte 


32 




13 






Isabela 








4 
11 






Leyte 




11 


Laguna 


1 








Misamis 
















Mountain Province _. 


56 


6,832 


34 


3, 523 


6 


17 


76 






Nueva Vizcaya 


27 
66 


1,550 
10, 487 


4 
70 


277 
10, 990 






4 


Occidental Negros 


11 




1 
























63 
72 
69 


9, 371 
14, 396 

6,767 


32 
118 
15 


6,097 
11,663 
3,441 






4 
13 
15 


3 


Panp^asinan 


11 
12 


16 


Rlzal 


2 








8 
11 

78 
72 
23 


540 
2,999 
10, 922 
10, 676 
3,865 


4 


500 


2 


:::::::::: ::::::::: 








Tarlac .-- 


30 
23 

18 


1.682 
1.999 
4,000 


2 
9 


3 
10 


13 


Tayabas . __ . 


13 


Zambales 












Total - 


1,418 


186, 233 


989 


118, 151 


403 


113 


280 







The total number of schools scattered throughout the Islands 
has not been inspected due to lack of time and of sanitary 
personnel. 

In making these inspections, however, the work was confined 
not only to physical examination of school children, but also to 
verify the sanitary condition of school buildings and toilet fa- 
cilities. 

In regard to sanitation of buildings, it should be stated that 
many schools, especially the rural ones, were found to have 
insanitary yards and not a few of them are lacking in toilet 
facilities. 

Due to shortage of proper school buildings, many primary 
schools are established in houses and places without proper fa- 
cilities for the purpose. 

In regard to the physical examination of school children, (See 
Table Q) nothing important has been noted. The most impor- 
tant diseases found were dental caries and scabies. With only 
few exceptions, the diseases found to have appeared have had no 
influence to any great extent on the health of the pupils. 

168426 9 



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131 

The great majority of the pupils excluded and found sick were 
treated, either at their homes or at the dispensaries, and read- 
mitted to the schools after recovery. 

X 

WATKR SUPPLY. 

The following Table R shows the sanitary water supply sys- 
tems used in the provinces, comparing two consecutive years. 

Three hundred sixty-one artesian wells were drilled during 
the year, the Province of Pangasinan being at the head as to the 
number of artesian wells. Two thousand one hundred-nine 
artesian wells were in operation at the close of the present year, 
furnishing about 28,000 gallons per minute, and used by about 
2,003,950 persons. 

Also 2,706 sanitary wells were dug during the present year, 
making a total of 34,975 at the close of the year 1918. The other 
two hundred and twenty-seven systems of water supply consist- 
ing of springs, gravity hydrants and rain water collected in 
containers above ground are also used by the people. 

In short it may be concluded that of the 7,968,767 persons 
who constitute the population of the provinces included in this 
division, about 3,000,000 or 37 per cent use safe water 2,000,000 
or 25 per cent use water with relative safety and the rest use 
water from rivers or unsafe water. 

An estimated amount of ^600,000 has been appropriated by 
the municipalities for drilling artesian wells, but due to lack 
of enough drilling outfits and personnel in the Bureau of Public 
Works, the total number of artesian wells proposed could not 
be drilled in the course of the year. 

The question of using a safe water supply is a very important 
matter in relation to health conditions of a province. During 
cholera epidemics it has been observed that the disease has re- 
gistered more cases in places where safe water is not available, 
and the same may be said with reference to the other intestinal 
diseases. With the extension of drilling more artesian wells or 
other sanitary systems of water supply, it is expected that the 
mortality, especially from gastro-inteetinal diseases will probably 
decrease to a minimum rate. 

Only 63 markets and 24 slaughterhouses were built during the 
present year. The small number of markets and slaughterhouses 
constructed was due to the high cost of materials for construction. 

Of the 497 markets existing at the end of the present year, 
only 150 are of concrete, the rest are of light materials, such as 
bamboo and wood. Also of the 281 slaughterhouses, only 75 are 
built of concrete. 



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134 

Ordinarily the sanitary maintenance of public markets and 
slaughterhouses is placed under the control of the municipal trea- 
surers, who frequently pay little attention to enforcing the 
cleaning of the above-mentioned buildings. 

On market days, sanitary inspectors of the municipalities 
and also the health officers whenever possible make an inspection 
of markets to see that sanitary regulations or municipal ordin- 
ances with regard to prevention of contamination of foodstuffs 
are complied with and that the tiendas are provided with food 
receptacles and a safe water supply. 

XII. 

DISPOSAL OF EXCRKTA. 

A circular was sent by the Central Office to all district health 
officers enclosing a draft of a municipal ordinance for the purpose 
of introducing throughout the population of the Islands the so- 
called **Antipolo system'' for excreta disposal. 

The Antipolo system consists of (a) a covered pit, (6) a seat 
with a pipe connected to the pit and (c) a ventilating pipe. The 
capacity of the pit varies; one to accommodate five persons or 
less should have a capacity of 6 cubic meters (1| meters deep 
by 20 meters square) and another cubic meter should be added for 
each person in excess of five. If the soil is sandy or soft, the 
sides of this pit should be lined with concrete, iron, stone, wood, 
bamboo or other permanent material to prevent slides of the 
earth into the pit. The top of the pit should be securely covered 
with concrete, stone wood or bamboo and whenever wood or bam- 
boo is used, it should be covered by at least 15 centimeters of clean 
earth. The opening in the seat is provided with a cover by 
which it is closed automatically when not in use. The pipe con- 
necting the seat to the pit is of galvanized iron, vitrified or 
burned clay, or other permanent material and should have a 
minimum inside diameter of 20 centimeters. All the joints of 
the pipe are made impermeable. The ventilating pipe is erected 
from the pit and the top should be one meter higher than the 
highest eaves of the houses nearby. A cap of wire screening 
should be fastened securely over the top of the vent pipe to 
prevent the entrance or exist of mosquitoes or flies. (See 
pictures.) 

Where the ground is low and became overflowed, the brink of 
the pit should be elevated above the level of the soil with stones, 
clay or earth firmly held in place with iron, wood, bamboo or 
other permanent material. 



135 






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136 

The elevation of the brink should depend upon the locality and 
it should be high enough so that the pit will not be overflowed. 
The thickness of the elevated brink, if the material used is earth 
or clay, should be 50 centimeters to prevent outside water from 
leaking into the pit. 

It is suggested that, if possible, pits be dug to a depth until the 
water oozes from 3 to 5 inches. When on account of the location 
of the ground, water does not percolate, the bottom of the pit 
can be made absorbent by pouring a bucket of water into the 
pit through the soil pipe occasionally. Water quickens the 
processes of putrefaction of the excrement without giving rise 
to offensive smells. Experience has demonstrated that by keep- 
ing the parts of this toilet in good repair, the upper part of the 
pipe connected with the seat constantly clean by scrubbing when 
necessary, and the bottom of the pit covered with water, this 
privy will be ordorless and its contents will be thoroughly di- 
gested. Should the water in the pit, through carelessness or 
negligence, become a source of mosquito propagation, the 
nuisance may be remedied by pouring into the pit a sufficient 
quantity of petroleum, that is, one hundred and fifty (150) cubic 
centimeters for each square meter of surface. 

By using bamboo material and Baliuag pipe, this system of 
toilet will cost only from 15 to 20 pesos. A regular public Anti- 
polo closet from four to six seats, partitioned for males and 
females, and with two separate doors, iron roof, wooden walls 
and concrete or Maycauayan stone tank will cost from 1P250 
to ^300. 

A municipal ordinance enforcing the use of the above described 
system for excreta disposal was submitted to all the municipal- 
ities of the provinces embraced by this division, but only 228 
have already approved it and 221 are taking it under consider- 
ation and study. Although 228 municipalities have approved 
the sanitary ordinances relative to the disposition of excreta, 
none of them have enforced it. One main reason why the munic- 
ipal councils offer objection against its enforcement or do not 
approve same is that, the cost of the construction of closets is 
prohibitive for the average poor people. But it is really due 
also to the fact that while the municipalities do not possess 
sanitary closets for municipal buildings and other public houses, 
it would be unfair to impose an ordinance of which the same 
municipalities are infractors. 

It is true that during the present year more Antipolo systems 
have been constructed in private premises than during the past 



137 

year, but comparing the total number existing at the end of the 
year and adding to it the number of other sanitary systems in- 
stalled in public places, only 73,620 are established in the provin- 
ces embraced by this Division, which are hardly sufficient for the 
maintenance of a sanitary disposal of excreta of about 8,000,000 
population of the provinces included in this Division. 

The Philippine Health Service is of the opinion that the so- 
called Antipolo system for the disposal of excreta is within the 
reach of all, and the provincial and municipal officers are there- 
fore responsible for the lack of sanitary disposal of excreta 
among the municipalities due to their negligence in enforcing 
the municipal ordinances proposed, inasmuch as section 2242 of 
the Administrative Code contains legislative powers of mandatory 
character for the municipal councils to pass an ordinance govern- 
ing the disposal of excreta. 

XIII. 

CEMETERIES. 

Fourty-four Roman Catholic, 12 Philippine Independent, one 
Protestant, and 78 municipal cemeteries were opened, and 17 
Roman CatTiolic, 1 Philippine Independent, one Protestant, and 
8 municipal cemeteries were closed during the year. At the 
close of the present calendar year, there exist in the provinces 
embraced by this division 846 Roman Catholic, 140 Philippine 
Independent, 77 Protestant, and 736 municipal cemeteries, mak- 
ing a total of 1,799 cemeteries. (See following Table U.) 

The work of the improvement of cemeteries which was begun 
last year has been continued during the present year, especially 
with regard to converting every one of the cemeteries into a 
beautiful garden. Some of the parish priests have introduced 
great improvements in their cemeteries, while the same practice 
is not true with reference to municipal cemeteries which still 
remain in bad condition, making them a place for pasturing of 
carabaos, horses and goats. 

XIV. 

NEW ORDINANCES. 

Sanitary ordinances covering the following points were sub- 
mitted by health officers to the municipal councils in their res- 
pective health districts. 

(a) Disposal if excreta. 

(6) Notification and control of communicable diseases. 

(c) Making compulsory the hospitalization of smallpox cases. 

(d) Measures against rabies. 



138 






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139 

(e) Making compulsory the muzzling of dogs. 

(/) Protection of food and drinks. 

(g) Sanitary control of aerated water factories. 

(h) Protection of water supply. 

(i) Sanitary maintenance of barber shops, pansiterias, ca- 
renderias, and other similar tiendas. 

ij) Sanitary maintenance of premises. 

(k) Sanitary maintenance of stables and dairies. 

(0 Drainage of low lands. 

(m) Slaughter permits. 

(n) Prohibition of spitting in public places. 

(o) Regulating dancing halls and making compulsory the 
physical examination of dance-hall girls. 

(p) Making compulsory the notification of births. 

(q) Regulating the practice of midwives. 

Not all of the municipal sanitary ordinances submitted were 
approved in all municipalities of the provinces. Only some of 
them were approved and in only some of the municipalities. 

The subjects of the sanitary ordinances submitted are prac- 
tically the same as those submitted last year, and the reasons 
why some municipal councils are reluctant to pass the ordinances 
submitted are the same as those stated in pages 109 and 110 
of the Philippine Health Service annual report for the calendar 
year 1917. 

It is self-evident that while sanitary ordinances cannot be 
enforced by the Central Government, no efficiency will be gained 
with regard to this point in municipalities. 

XV. 

SANITARY ORDERS AND PROSECUTIONS. 

The following Table V shows the number of sanitary orders 
issued during the year, the cause for which they were issued, 
the number of persons prosecuted, and the results obtained 
from the prosecutions. 

The number of persons prosecuted in relation to the number 
of sanitary orders issued, and also the number of persons pro- 
secuted in relation to the persons sentenced appear to be quite 
small. This is due to the fact that in some municipalities local 
officers, instead of showing themselves interested in health mat- 
ters and cooperating with the health officers, do not pay much 
attention to this important matter. Although repeated per- 
sonal conferences were held with some of them in regard to 
sanitation, no results were obtained. This condition is either 



140 



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141 

the result of the indifference of the officials concerned or of 
political influences. The election for members of the Legis- 
lature and provincial and municipal officials to be held in the 
second quarter of next year will explain this fact. 

XVI. 

PUBlilCITY. 

Besides public lectures given by the personnel of the health 
organization, the number of which may be seen in the following 
table, lectures which constitute a part of the publicity campaign 
and other activities have also been carried out for the same 
purpose to the end that the people may familiarize themselves 
with sanitary measures, and may understand the importance 
of sanitation. 

The health officers have taken advantage of every opportunity 
to publish and attract the attention of the people towards health 
matters. This work has been performed in different ways 
either by publication of pamphlets, bulletins, conferences, exhi- 
bitions, etc., impressing upon the mind of the people the im- 
portance of sanitation by making comparative vital statistics 
or by exhibits which were usually made during town fiestas, 
garden days, etc. Exhibitions of the Antipolo system of toilet, 
model house, sanitary water receptacles, pictures, ova of intes- 
tinal parasites, mosquitoes, how to avoid malaria, flies as 
nuisance and vectors of diseases have been made during the 
present year in almost all the provinces embraced by this 
Division. 

Considering the great importance of this work, this division 
has directed its activities especially to the greatest possible ex- 
tension of the publicity campaign. 

XVII. 

HOME GARDEXS. 

The following Table Y shows the number of home gardens 
established during the year. 

The campaign for the establishment of home gardens and for 
the increase of food production has been carried out by the 
personnel of the health organization with the cooperation of 
the Bureau of Agriculture, Bureau of Education and the local 
authorities, as a part of the plan of the Central Government 
and as a measure to provide food for the World war. 

In order to obtain the greatest possible success in this cam- 



142 






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I 



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143 



Table Y. — Home gardens established during the 


year. 




Provinces. 


Number 
of pre- 
mises. 


Number 
of per- 
sons to 
whom 
seeds 
were dis- 
tributed. 

2,534 


Number 
of home 
grardens 
actually 
planted. 


Albay . . 


2,682 


2,922 


Ambos Camarines _ 


8,538 


Antique _ . . . _. 


3,768 


2,487 

556 

3.601 


1,867 


Bataan 


776 


Bulacan 


3,601 
14, 489 
14, 065 


3,601 


Batangras _... _ _. 


14, 788 


Bohol 


6,443 


5,587 


Cavitea... . 




Cagayan . ._ . . _ . 






9,171 


Cebu a __. - --- 








Capiz -- - 


6,912 

4,552 

127, 265 


6,912 
2,907 
5,382 


6,037 


Iloilo 


5, 188 


Ilocos Norte 


102, 761 


Ilocos Sur _ 


36. 249 


Isabela 


4,009 
3,132 
2,061 




1 778 


La Union . 


5,266 

1,696 

950 

417 

1,957 


9,146 


Leyte .-» . 


1.089 


Laguna 


5,906 


Mindoro.. 


1,194 
1,555 
5,312 
3,334 
17, 869 


326 


Mountain Province __ . . 


1,476 


Nueva Ecija _ . 


5 312 


Nueva Vizcaya 




1,155 


Occidental Negros _. 


287 


12,792 


Oriental Negros a ... 




Palawana .. .. .. ._. 








Pampanga ... 


18, 110 
34.212 
2,270 


13,050 
7,827 
1,692 


9.055 


Pangasinan 


52 737 


Rizal 


1,342 


Romblon . . . 


280 


Samar _ 




20,224 

1,669 

162 

6,562 

15 

928 


4,445 
1,482 


Sorsogon.- .. .. 


2,034 


Tarlac — .. .-_ 


18, 229 
5 275 


Tayabas _ 


3,275 


Zambales.- _... . . . 


7,449 


Batanes . 


185 


185 






Total 


295, 802 


99, 518 


330, 462 







" No data. 

paign, several cooking contests have been celebrated in the prov- 
inces. These contests were usually celebrated between school 
children of different towns and their principal object was chiefly 
to encourage the interest of the people towards preparing their 
own food with materials available in each locality, taking also 
into consideration the value as food of each recipe prepared. 

XIX. 



CLEAN-UP-WEEK. 

Clean-up-week work has been carried out this year under the 
same plan as that of last year. All yards, gardens, etc., were 
cleaned, wells disinfected, fences repaired or constructed, houses 
cleaned and repaired, garbage and other refuse burned or 
buried, mosquito breeding places destroyed and in general all 
nuisances abated. 



144 
XX. 

MISCELLfANEOUS. 

AUTOMATIC HEALTH CONTROL. 

Cebu, — As already intimated in the 1917 annual report a 
party composed of five commissioned officers of this Service, 
five assistant sanitary inspectors and five nurses left Manila in 
March, 1918, for the Province of Cebu under the supervision 
of Passed Assistant Surgeon L. R. Thompson of the U. S. Public 
Health Service, and Miss Ora Bruchmiller as supervising nurse. 
The commissioned officers were Senior Surgeons Felipe Arenas 
and Jose Avellana Basa, Surgeons Juan S. Fernando, Jose T. 
Chaves and Bonifacio Mencias; Assistant Sanitary Inspectors 
Gerardo Simon, Filemon Ochoa, Jose Maglaque, Raymundo 
Peiia and Filomeno Carreon; and Nurses Barbara Sacro, Ro- 
sario Maravilla, Valeria Alano, Carmen llano and Florencia 
Urquico. The party was divided into several units each, each 
unit composed of one doctor, one assistant sanitary inspector and 
one nurse. The purpose of the commission was to carry into 
practice the principles of the Automatic Health Organization 
in the Province of Cebu, as laid out in the scheme of the ''Sani- 
tary Health Control System;'' and to instruct the district 
health officers and presidents of sanitary divisions in the me- 
thods of said system. Each unit remained in each division the 
necessary time to complete the instruction. 

Time employed by each unit. — One month was the average 
time employed by each unit to complete the collection of the 
sanitary census, and the compilation, recording, indexing of 
cards and the preparation of the health index charts, maps 
mortality and morbidity charts, weekly reports, etc. 

It was very much regretted that due to cholera which was 
then epidemic in the province and to the various sanitary divi- 
sions having no doctors as presidents thereof, the results ob- 
tained were not as satisfactory as was expected. The apparent 
apathy of most of the local health officials who did not seem 
to take much interest in learning and following the instruc- 
tions given to them by the members of the party contributed 
also to its failure. Nevertheless, quite a few improvements 
were achieved with the inauguration of this system as follows : 

Weekly deaths occurring in each municipality are now re- 
ported by each president of sanitary division to the district 
health officer, giving the death rate per thousand population 
in the health index for each district. 



145 

This report is filled on a standardized form, giving also in- 
formation regarding the personal data of the deceased, the 
duration of illness, and the provisional diagnosis by either the 
sanitary inspector or the municipal secretary when these officers 
sign the death certificate, and the final diagnosis by the presi- 
dent of sanitary division. With this new system of recording 
deaths in the municipalities the following undesirable conditions 
are now being remedied : 

1. Reduction of incorrect, undetermined and absurd "diag- 
nosis" to the minimum. 

2. Presidents of sanitary divisions are now likely to become 
aware of any increase in the number of deaths so that they are 
apt to advantageously investigate every one of the deaths occur- 
ring in the municipality, in this way correcting the diagnosis 
and detecting a threatening outbreak of any epidemic. 

3. With the weekly mortality reports received from his pres- 
idents of sanitary divisions the district health officer, in his 
turn, is always aware of the health conditions of every town 
or health district under his charge and is able to notice the cause 
of any undue sudden increase or prevalence of high mortality 
in any one of the municipalities comprised within the district. 

4. Occult cases are caused to be indirectly discovered through 
the investigation of the mortality records. 

5. Prompt, reliable and specific measures may be taken by 
the local health officer due to the accurate and quick information 
obtained from the system. 

6. And above all, it is beyond question that by this gradual 
instruction and training of the sanitary personnel of the province 
in true, scientific and efficient sanitary control, the health condi- 
tions of the Province of Cebu shall necessarily be very much 
improved. 

Bulacan. — The Province of Bulacan was also selected for the 
same standardization. The members of the commission formerly 
detailed in Cebu were ordered to proceed to Bulacan in August 
and start the same work there. 

Time employed to complete the work, — The work was inau- 
gurated on August 19 and was closed on December 3, 1918, a 
period of three and a half months. 

Due to the comparatively better health organization of this 
province the new system was not so hard to inaugurate and 
establish in the various sanitary divisions of the province, as 
each of these divisions was under the charge of a physician 
and fairly complete subordinate personnel. 

168426 10 



146 

Units. — The party was divided in several units, one unit taking 
charge also of the district health officer's office. 

Cooperation and enthusiastic willingness to learn and adopt 
the methods of the new system were found on the part of the 
district health officer, presidents of sanitary divisions and sub- 
ordinate personnel as well. They had individually applied great 
attention and interest toward the prompt acquisition of all neces- 
sary instruction for the establishment and proper running of 
the health control system in their respective districts. 

This was made clearly evident by the fact that after about 
one month's period of instruction the offices of the presidents of 
sanitary divisions were already equipped with all information, 
record cards, charts on mortality and health index weekly re- 
ports being submitted to the district health officer. 

The following information was collected, recorded and filed 
in the office of each president of sanitary division : 

1. Family records, which embrace the following data: (a) 
Persons in each family; (h) number of persons never or posit- 
ively vaccinated; (c) deaths occurring in the family and cause 
of death; (d) water supply, its type, location and other sanitary 
conditions; (e) sewage disposal; (/) stables; (g) food; (h) 
lowland or mosquito breeding areas. 

2. The following record cards were arranged and filed: (a) 
Water supply record cards, which were classified into different 
groups according to the class and type of supply, for general 
supply, public supply on private premises, and private supply. 

3. Record cards of tiendas. — This card gives the following 
information : 

(a) Location of tienda: (fo) class of tienda; (c) name of 
owner; (d) number and names of persons employed in tienda; 
(e) class of articles sold; (/) origin of fresh food sold; (g) 
sanitary condition. 

4. Record and ready reference cards were also made of stables 
and toilet facilities. 

5. Sickness information, — Record of all known cases of dan- 
gerous communicable diseases were also prepared and filed. 
Cards were classified and recorded according to diseases. 

MORTALITY INFORMATION. 

This part of the work was given the most particular attention 
as in the absence of reliable morbidity records, it was necessary 
to rely on the mortality records as an indicator of the prevalence 
of epidemic diseases. 

The death records of each municipality were studied and 
tabulated as follows : 



147 



(a) The total deaths and death rats by years and age groups 
and the average death rate per 1,000 population for the five- 
year period. 

(6) The average death rate per 100,000 population from 
each specific cause for the above mentioned period of years. 

(c) Comparison of death rates between municipalities com- 
prised in one Sanitary Division giving also the specific death 
from all causes for each municipality. 

(d) A study of the weekly variation or changes of the death 
rate by means of the weekly health index. The reason for 
tabulating the deaths in weekly periods is to provide the health 
officer with a health index both of his municipalities and his 
sanitary districts. 

(/) In connection with the health index which was furnished 
by each president of a sanitary division for each of the munic- 
ipalities under his charge, a standardization of the classification 
of deaths was also inaugurated by means of a standard form 
like that used in the Province of Cebu with a few amendments 
introduced. 

Tables illustrating the points described under paragraphs 
(a), (ft), (c) and (d) are as follows : 

Table AA. — Deaths and death rate by years {1913-1917) and age groups. 

[Municipality of Paombong.] 



Years. 


Popula- 
tion. 


Deaths 

under 1 

year. 


Death 
rate 
per 
1,000 
popula- 
tion. 


Deaths 
under 5 
years. 



37 
73 
80 
166 
33 


Death 
rate 
per 
1.000 
popula- 
tion. 


Deaths 
over 5 
years. 


Death 
rate 
per 
1,000 
popula- 
tion. 


Total 
deaths. 


Death 
rate 
per 
1,000 
popula- 
tion. 


1913 


9,921 
9,956 
10, 113 
10, 153 
10, 291 


96 
111 
121 
146 
130 


9.67 
11.14 
11.96 
14.37 
12.64 


3.72 
7.33 
7.91 
16. 33 
3.20 


100 
132 
93 
166 
119 


10.07 
13.25 
9.19 
16. 33 
11.57 


233 
316 
294 

478 
282 


23 48 


1914 

1915 ; 

1916 


31.73 
29.07 
47 07 


1917 


27 42 






Total 


50, 424 


604 


11.97 389 


7.71 


610 


12.09 


1,603 


31.79 



By means of this table the health officer will be able to ascertain 
the normal death rate of each town or municipality under his 
charge thus being also aware when the death rate of the year 
just ended is higher than being also aware when the death rate 
of the year just ended is higher than the normal death rate of 
that district. Thus in the year 1916 the death rate was com- 
paratively higher than other previous years as it reached 47.07 
per 1,000, the cause of this high rate being cholera which was 
epidemic in the municipality of Paombong. A tendency to 
drop is ncfted in the year 1917. 



148 



Table BB. — Principal census of death summary. 

[Municipality of Paombonj?, Bulacan. Total population for five years (1913-1917), 50,424.] 



Causes of death. 
Typhoid fever . ._ _ . 


Under 1 
year. 


1 year to 
under 5 
years. 

1 
14 


Over 5 
years. 

15 

55 


Total. 

16 

70 


Death 
rate per 

luo.ooo 

popula- 
tion. 

31.72 


Malaria . 


1 


138. 81 


Smallpox - 




Measles .* 


5 
2 


4 
12 


2 


11 
14 


21. 81 


Wooping cough 


27.76 


Diphtheria _ . _ _ .. . . 






Influenza 




1 






Cholera . 




10 

93 

23 

3 


59 
28 
41 
151 


69 

135 

105 

154 

1 

27 

316 

84 

1 

1 

1 

55 

65 

54 
4 


136. 83 


Dysentery -..--_ 


14 
41 


267. 71 


Beriberi 


208. 22 


Tuberculosis of lungs _ 


305. 39 


Cancer . . 




1,98 


Meningitis . 


13 

278 
67 


14 
37 
16 


53.54 


Convulsions of infants -. . . . 


1 


626. 65 


Acute bronchitis 


166. 58 


Chronic bronchitis , 


1.98 


Bronchopneumonia.. 






1.98 


Pneumonia 






1.98 


Diarrhoea and enteritis — 2 


55 




109. 06 


Diarrhcea and enteritis — 2 


--- 


5 


128. 90 


Diseases of Infancy: 

1 congenital debility 


54 

4 


107. 08 


2 other diseases . -..._._. 






7.93 


3 lack of care 








Tetanus umbilical .. .. 


20 






20 
2 

21 
13 
1 

1 

99 

129 

7 

75 

1,603 


39.66 


Tetanus 


1 
13 


13 

7 

99 
46 

72 


3.96 


Rickets 


7 


41.64 


Accidents of labor . ._ .. 


25.78 


Puerperal hemorrhage _ 






1.98 


Erisipelas ._ . . . .. ._ 


27 


18 


103. 12 


Anemia .. 


1.98 


Senility 






196. 32 


lUdefined .- 


16 


67 


255.81 


Undetermined 


13.88 


All other causes _. __ 




3 


148. 73 




604 
1, 197. 79 




Total 


389 
771.42 


610 


3, 178. 90 






Death rate per 100,000 population 


1, 209. 69 











From the study of the above table, the presidents of sanitary 
divisions are able to deduce the following important information : 
That by order of importance, the chief causes of mortality in 
the town of Paombong are ''convulsions of infants," ''tubercu- 
losis of the lungs," "beriberi" and "dysentery." Of these di- 
seases, constituting the chief causes of deaths, three of them, 
tuberculosis, beriberi and dysentry are preventable. Infantile 
convulsions may also be considered as a preventable disease, 
as this term only indicates a symptom which may be produced 
by any of the well known preventable diseases. For the reduc- 
tion of the mortality rate the health officer shall therefore direct 
his campaign specifically against these diseases. 



149 



Fable CC. — Death rate per 1,000 population by age groups and by munic- 
ipalities. 

[Philippine Health Service. Sanitary Division No. 1. Province of Bulacan, P. I.] 



I I Tola] iDeaths!^ ., Deathslp. ., Deaths rv-_.i,„ 

Municipality, i Years. ' popula- | under | __t„ ""^^^ i rate i «^*^^^ rntl 
tion. I 1 year. I ' 5 years.; ; years. ! ^**^®" 



Malolos I 1913-1917 

Paombong ...i 1913-1917 



157.963 I 1,306 



50, 424 



604 



I 



8.27 
11.97 



644 t 
389 i 



! i 

4.08 1.795 ! 11.36 
7.71 610 i 12.09 



Total 
deaths. 



3,745 
1,603 



Deaths 
rate. 



23.71 
31.79 



Table DD. — Specific mortality by municipalities. 

[Death rate per 100,000 population, 1913-1917.] 



Cause of death. 



Total 
deaths. 



Typhoid fever 

Malaria 

Smallpox 

Measles 

Whooping cough 

Diotheria 

I nfluenza 

Cholera 

Dysentery 

Beribe'i 

Tuberculosis of lungs . 

Tuberculosis other organs. . 

Cancer 

Meningitis _. 

Convulsions infants 

Acute bronchit's 

Chronic bronchitis 

Broncho pneumonia 

Pneumonia 

Diarrhea and enteritis— 2 .. 
Diarrhea and enteritis— 2 . . 

Congenital debility 

Other diseases 

Lack of care 

Umbilicas tetanus 

Rickets 

Atrepsia 

Accident of labor 

Puerperal septichamia 

Puerperal hemorrhage 

Erisepeias 

Intestinal parasite .- 

Anemia 

Rabies- 




Malolos. 



Death 
rate. 



14.56 
58.56 



Plague 

Nephritis 

Senility 

III defined 

Undetermined , _ . 
All other causes 



5 i 

14 1 
2 ! 

1 ! 

282 

74 
199 
332 

74 

3 

271 

363 

143 



6 

1 

115 

133 

102 

58 

22 

43 

35 

117 

17 

7 

1 

79 

52 

94 

4 

1 

100 

203 

196 

58 

422 



3.16 

8. 86 

1.27 

0. 63 

178. 62 

46.84 

125. 97 

210. 17 

46.84 

1.90 

171.55 

229. 79 

90 52 



0.(^3 

72.80 

84.19 

64.57 

36.61 

13.92 

27.22 

22.16 

74.06 

10.76 

4.43 

0.63 

50.01 

32.93 

59.51 

2.53 

0.63 

63.30 

128. 50 

124.07 

36.71 

267. 13 



Paombong. 



69 
135 
105 
154 



1 

27 

316 

84 

1 

1 

1 

55 

65 

64 



99 
129 

7 
75 



Death 
rate. 



31.72 
138.81 



21. 81 
27.76 



136. 83 
267. 71 
208. 22 
305.39 



1.98 

53.54 

626. 65 

166. 58 

1.98 

1.98 

1.98 

109. 06 

128. 90 

107. 08 

7.93 



39.66 
41.64 



L98 
103. 12 



196.32 

255. 81 

13.88 

148. 73 



By a study of the above table the health officer is able to as- 
certain which of the municipalities of his division needs the 
most intensive sanitary v^ork. The prevalence of preventable 
causes of deaths is clearly compared by one municipality with 
another. 

Paombong shows a higher death rate than Malolos. This 
town therefore is in greater need of efficient sanitary work than 
Malolos. 



150 
Table EE. — Weekly health index. 

[Municipality of Hagonoy, Bulacan.] 



Estimated population in July 1. 1918, 25,993. 
Death rate for the corresponding weeks, 1918. 



With 
epidemics. 



Without 
epidemics. 



Average population for five 
years (19181917), 25,148. 



Average deaths and death rate 
for the corresponding weeks, 
1913-1917, epidemics excluded. 



Week 
ending— 



! Death ' ! Death | i Death ; 

T, .^, Irateper: rp^^_, rate per; Deaths rate per rp .. i 
7^^,J^ I l.OUO 7f^' 1,000 I under I 1,000 .^^J?' 
^^^^^^•iPopula-; '^^^^^'- popula-l 1 year, popula-^^^^^^"- 

j tion. I tion. tion 



January 5 

January 12..- 
January 19... 

January 26 

February 2... 
February 9... 
February 16 ._ 
February 23.. 

March 2 

March 9 

March 16 

March 23 

March 30 

April 6 

April 13 

April 20 

April 27 -...-- 

May 4 

May 11 

May 18 

May 25 

June 1 

June 8 

June 15 

June 22 

June 29 

27 i July 6 

28 July 13 

July 20 

July 27 

August 3 

August 10 

August 17 

August 24 

August 31 

September 7 . 
September 14. 
September 21. 
September 28 

October 5 

October 12 ... 
October 19 ... 
October 26 ... 
November 2.. 
November 9.. 
November 16. 
November 23 
November 30. 
December 7 .. 
December 14 . 
December 21 . 
December 28 . 



68.0 
54.0 
72.0 
74.0 
54.0 
38.0 
30.0 
34.0 
34.0 
48.0 
28.0 
34.0 
40.0 



32.0 



17 
19 
16 
30 
22 
26 
17 

22 I 

23 I 
13 ! 
17 1 
17 I 
27 
27 
19 
21 
20 
26 
18 
18 
16 
27 
27 
24 
29 
22 
32 
34 
25 
15 
14 
14 
16 
19 
12 
16 
19 
24 
15 
18 
11 



34.00 I 

38.00 

32. 00 

60. 00 

44. 00 

52.00 

34. 00 

44. 00 

46.00 

26. 00 

34.00 

34.00 

54.00 

54. 00 

38. 00 

42. 00 

40.00 

52. 00 

36. 00 

36. 00 

32. 00 

54. 00 

54.00 

48. 00 

58.00 

44.00 

64.00 

68. 00 

50.00 

30.00 

28.00 

28.00 

32 00 

38.00 

24.00 

32.00 

38.00 

48.00 

30.00 

36.00 

22.00 



Death i Death 

rate per Deaths rate per 

1,000 ^ under 1,000 
popula-^ 1 year, popula- 
tion. I tion. 



I 



28. 00 
22. 00 
12. 00 
30.00 ! 
28.00 ; 
32.00 ! 
16.00 j 
16.00 i 
16.00 i 
16.00 I 
22.00 i 
16.00 ' 
22.00 I 
26. (X) ' 
22.00 ! 
20.00 ; 
18.00 I 
22. 00 
20. 00 
16.00 
20.00 I 
30.00 I 
16.00 ! 
22, 00 i 
34.00 ! 
20.00 ; 
16.00 I 
24.00 j 
16.00 ' 

8.00 i 
18.00 
16.00 

8.00 
16.00 

8.00 
18.00 
12.00 
28.00 
14.00 
20.00 
12.00 



14. 00 
15. 20 
15.00 
12.00 
14. 00 
14.20 
14.00 
13.00 
14.40 
12.40 
12.00 
11.00 
12.40 

13. 20 

14. 00 
12.20 
12. 00 
14.20 
17.20 
12. 00 
12.40 
14. 00 
12.20 
15.20 
17.40 
19. 00 
18.40 
14.40 
15.00 
16.00 
13.00 
13.20 
13.00 
14.00 
13.00 
15.00 
13.00 
11.00 
13.00 
10.00 
12.40 
10.40 
18.00 
11.20 
14.40 
12.00 
12.00 
18.00 
16.40 
11.00 
17.20 
15.00 



29.00 j 
81.42 I 

31.01 I 
25.00 
29.00 
29. 36 
31.01 
27. 00 
30. 00 
26. 00 
25. 00 
23. 00 
26. 00 
27. 29 
29.00 
25. 32 
25.00 
29.36 
35.56 
25. 00 
26.00 
29. 00 
25.32 
31.42 
35.00 
39.28 
38.04 
30.00 
31.01 
33.08 
27.00 
27.29 
27.00 
29.00 
27.00 
31.01 
27.00 
23.00 
27.00 
21.00 
26.00 
21.50 
16.54 
23.17 
30.00 
25.00 
25.00 
37.21 
34.00 
23.00 
35.56 
31.01 



5.40 
9.00 
7.00 
5.20 
8.00 
7.00 
6.40 
5.00 
4.20 
7. 00 
5.00 
4.40 
5. 20 
6.00 
6. 20 
6.00 
5.00 
5.40 
6.20 
4.40 
5.20 
5.40 
6.00 
5.00 
8.00 
7.00 
7.20 
5.00 
4.20 
5.00 
4.40 
5.00 
4.40 
5.20 
5.20 
7.00 
5.20 
5.00 
6.00 
4.00 
6.20 
6.00 
4.00 
6.00 
6.00 
6.00 
6.00 
9.00 
8.20 
6.00 
9.00 
6.00 



! 



11.16 
19. 00 
14.47 
11.00 
16.54 
14.47 
13. 23 
10. 33 

9.09 
14. 00 
10.40 

9.09 
11.60 
12. 40 
13. 00 
12. 40 
11.16 
10. 33 
13. 00 

9.09 
11.00 
11.16 
12. 43 
10. 30 
16.54 
14.47 
15.00 
10.33 

9.00 
10.33 

9.09 
10.33 
19.09 
11.00 
11.00 
14.47 
11.00 
10.33 
12.00 

8.27 
13.00 
12.40 

8.27 
12.40 
12.40 
12.40 
12.40 
19.00 
17.00 
12.40 
19.00 
12.40 



The value of the Health Index for the health officer cannot be 
overestimated. By the weekly death rate a constant check of 
the death rate of a town is always had so that any threaten- 
ing outbreak of an epidemic is promptly noticed by the health 
officer. 



151 



Table FF. — Comparison of death rates by municipalities. 

[Province of Cebu, 1913-1917.] 



. 1 

O 

5 


Municipality. 
[Cebu 


Deaths 
lye 

Total 
deaths. 

453.6 
55 

84 

60 
95 
26 
34.6 

15.6 
13.8 
4.4 
61,6 
38.6 

40.4 
70. 8 
83.2 

26.8 
38.4 
76.6 
102.2 

23.8 


under 
ar. 

Rate 
per 
1.000 
popula- 
tion. 

7.71 
4.1 
5.6 

4.9 
4.8 
3.3 
3.3 

2.4 

3.0 

0.8 

3.27 

3.54 

4.65 
4.73 
13.9 

1.88 
2.30 
3.56 
5.32 

4.47 


Deaths 
5ye£ 

Total 
deaths. 


under | 
irs. j 

Rate 1 
per 1 

1.000 : 

popula-i 
tion. 1 

3.88 

6.2 

4.4 

3.7 
3.6 
4.4 
3.2 

2.3 
2.7 
4.6 
2.75 

2.70 

2.68 
2. 59 

2.08 

1.79 
1.75 
2.17 
3.80 

4.88 


Deathf 
5 yei 

Total 
deaths.' 

! 

518.4 1 
171 1 
148 

158 
177 

53 

50.4 

30.6 
27 
41 

132.4 
65.8 

50.6 
86.2 
95.8 

58.6 
72.6 
99.8 
118.4 

30.2 


i over 
irs. 

Rate 

per 
1,000 
popula- 
tion. 

8.81 
12.5 
9.8 

12.8 
8.8 
6.8 
4.8 

4.8 
5.9 
7.7 
6.8 
6.05 

5,82 
5.76 
3.1 

4.13 
4.33 
4.66 
6.14 

5.67 


Total d 

Total 
deaths. 

1, 200. 2 
310 
298 

263 
344 
112 
119 

60.8 
52.4 
73 
247.4 
133.8 

115.2 
195.8 
253.3 

112 
140. 5 
222. 8 
193.6 

80 


eaths. 

Rate 
per 

1,000 
popula- 
tion. 




228.2 
84 
66 

45 
72 
34 
34 

14.6 
11.6 
26.6 
53.4 
29.4 

23.2 

38.8 
54.2 

26.6 
29.4 
46.6 
73 

26 


20.4 


1 


•iMandawe - ..- 


22.8 




lOpon 


19.8 




f Li loan -- 


21.4 


2 


IDanao 

) Cordoba 


17.2 
14.6 






n.4 




Poro 


9.5 




Tudela 


1L5 


? i 


Pilar - . 


13.1 


1 




12.73 


1 




12.29 


4 


jBorbon 

{Tabog-on 

iBogo 

San Remigio .._ •_ 

Medellin 


13.15 
13.09 
8.99 

7.90 
8.4 


b 


Daan Bantayan 


10.36 




Bantayan 

(Santa Fe 


15.30 
15.03 


6 
7 






[Tuburan - - 


78 

50.4 
64 4 
102.6 

85.2 
42 
123 


2.57 

2.72 
6.31 
6.04 

5.17 
2.65 
4.5 


47.2 

46.6 

32 

4L6 

43.2 
32.2 
57 


L55 

2.52 
3.83 
2.44 

2.6 

L19 

2.1 


126.4 

90.2 
88.2 
135.6 

105.2 
80.2 
120 


4.17 

4.99 
8.64 
7.90 

6.35 
5.07 
4.4 




251.8 

187.2 
184.6 
270.8 

233.6 
152.8 
300 


8.80 


1 Asturias 


10.10 


■1 Balamban . _. _- 


17.59 


[Toledo 


16.46 




Pinamunganan 


113. 90 


H 




9.67 




Dumanjug - -_ 


ILO 




Barili 




9 






















Badian 


46.6 

104.6 
32.75 
69.8 
55 

37.2 

44.6 

224.6 

56.2 

(«) 

(b) 

76.8 

230.2 

198.2 
114.2 
57.4 

54.8 
71.8 
10L8 


3.46 

7.33 
5.61 
4.81 
4.66 

3.9 
3.41 
8 
6.6 


25.4 

49.8 
15.75 
47 
25.8 

34.8 
3L4 
152 
19.8 


L89 

3.44 

2.7 

3,24 

2.19 

3.65 
2.4 
5.4 
3.2 


70.2 

in.4 

34.75 
146 

82 

9L2 
103.6 
299.8 

58.2 


5.21 

7.70 
6.13 
10.07 
7.29 

2.57 
7.93 
10.8 
6.9 


142.2 

53L6 

84.2 

262.8 

166.8 

163.2 
179.6 
660.2 
134 


10.56 






18.37 




Alcantara -- 


14.44 


10 


iMalabuyoc 


18.12 






14.14 




fSamboan 


17.12 




JGinatilan 


13.74 


11 


1 Dalaguete - - 


24.3 




IBoljoon 


15.9 




Oslob 






















12 


Santander 


4.5 
6.5 

4.2 
3.4 
2.7 

4.5 
5.6 
5.4 


57.8 
158 

86 

69.8 

54.4 

80.2 

62 

82.8 


3.3 
3.8 

L8 
2.1 
2.5 

8.5 
4.8 
4.3 


124 
423.6 

303 

208.2 

162 

178.2 

m.8 

175.8 


7.2 
10.4 

6.5 
6.3 
7.5 

10.8 

10.3 

, 9.3 


258.6 
8n.8 

587.2 

392 

273.8 

333.2 
256.6 
360.4 


is. 9 






20 




Argao 


12.6 


13 


sSibonga. _. - 


n.9 




Naga - 


12.8 




iTalisay 


19.8 


14 


< Minglanilla 


20.7 




>San Fernando - -- 


19.2 









a With Santander. 



to With Dalaguet'>. 



152 



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5 i-ias M o 
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•<iOcoaidNi>t^'-5«OrHT 



ooooo 

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TjJ tH rH csi d (N iH N d CO 50 (N (N d d (N rH 



C^J(N(N(Ni-l(N(N<NJ»HT-lr-ieOrH<M<NIOOCOr-lrj<,-li-lNr- 



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iS 


s 


5S 


% 


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§ 




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P. 






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TtOC<IO00O'^OC<»<M'^'^00C<lO00O«i'^'«J'O(N'^ 

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OOOrf 
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17.00 
30.00 
26.2 
38.0 
11.54 
23.43 
17.28 
8.42 


lOrfOOMrHlONi-l 




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41.58 
20.87 
55.66 
10.98 
19.00 

""""67.'2'" 

'""'72."6'" 
68. 

""54.'79" 
34.56 
21.05 


j-'j'osoocgio '"^ j [ 1^3"^ 1 ' it-cou5 



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153 

Table HH. — Death summary. 

[Tuberculosis of lungs, 1913-1917.] 



Municipality. 



Under 1 
year. 



Paombong . 
Bulacan __. 

Bigaa 

Guiguinto.. 
Calumpit _. 

Baliuag 

Bustos - 



One year 
to under 
5 years. 



San Rafael... 
Santa Maria . 

San Jose 

Bocaue 

Polo . 



Obando 

Marilao 

Meycauayan .. 

Hagonoy 

San Miguel 

San lldefonso . 

Atigat 

Norzagaray .. 

Quingua 

Pulilan 



1 ! 



Over 5 
years. 



332 
154 
294 
186 
103 
304 
411 

30 
139 
267 

26 

29 
169 
193 

73 
204 
455 
297 
138 



211 

217 



Total. 



332 I 

154 

294 

186 I 

103 I 

304 

412 

30 
140 
268 

26 

31 
169 
195 

73 
204 
456 
297 
138 
166 



Death 
rate per 

1(K),()()0 
I popula- 
! tion. 

210. 17 
I 305.89 
411.60 
378.28 
424. 36 
861.76 
383. 94 
410.70 
305. 58 
318.24 
309. 70 
60.45 
341.88 
397. 80 
348. 10 
348. 84 
362.65 
392. 67 
414.00 
387.37 



211 
217 



474. 75 
364.56 



Tables FF, GG and HH will illustrate the summary of all in- 
formation regarding mortality statistics in each municipality so 
that they are all summarized and studied by the district health 
officer who by this centralized informations is able to keep a con- 
stant check on the sanitary condition of his district. At the 
same time his supervision and control over his subordinate 
personnel becomes so effective that if this system is used with 
due diligence the health work in the provinces will no longer 
constitute such a very hard problem to solve by those engaged to 
carry out same. 

It is needless to say that with the standardization of the 
sanitary divisions and the health districts the efficiency of both 
technical and administrative service in every province and the 
centralization of this standardized work with the Central Office 
will necessarily reflect towards the efficiency of the Philippine 
Health Service. 

CLOSING REMARKS. 

The activities of provincial health organizations and health 
officers during the year have been almost wholly directed toward 
the eradication of the cholera, smallpox, and influenza epidemics. 

The above explains why only few permanent improvements 
were effected during 1918 in provincial sanitary work. In cam- 
paigns undertaken to eradicate epidemics, the Service has been 



154 

confronted with the disadvantage of having an inefficiently 
trained personnel, many of the employees having either scant 
preparation, or none at all, to carry out the so-called modem 
science of preventing medicine, this fact contributing to a great 
extent to the difficulty encountered in preventing epidemics. 

It is true that health matters and their importance are not 
yet known to any extent in the provinces, and this is probably 
the fault of no one in particular, but many health officers were 
partly responsible in that they failed to show interest in their 
work. President of sanitary divisions and commissioned of- 
ficers of this Service having a salary lower than ^3,000 per 
annum are permitted to engage in private practice, because their 
salaries are considered insufficient at the present time. This 
fact appears to be the cause of their paying more attention to 
their personal interests than to public health matters. They 
just limit themselves (with few exceptions) to attend to routine 
work of the office, but do not endeavor to promote and increase 
the interest of the people towards sanitation, nor do they pay 
much attention to health problems. The actual health organ- 
ization has also its part in this problem, because the health fund 
is not centralized in an individual in each province and for this 
reason the amount appropriated either by the general fund of 
the province or municipal fund depends greatly upon political 
contingencies. 

There are also many provisions of law that leave the health 
officers forsaken if not completely hand-tied, placing them in an 
unbearable situation. 

So long as these conditions continue, a rapid and efficient pro- 
gress in the sanitation of the provinces is impossible. 

RECOMMENDATIONS. 

1. WITH REFERENCE TO HEALTH ORGANIZATION. 

(a) Revision of the Philippine Health Service law centraliz- 
ing all powers conferred upon the provincial boards and munic- 
ipal councils in the hands of the Secretary of the Department 
and the Director of Health. 

(6) Creation of a "Training School of Sanitation'' for com- 
missioned and noncommissioned officers in the Service. 

(c) Division of the Islands into sanitary districts assigning 
to each district an inspector who can make continuous and in- 
tensive supervision of subordinates as well as of the health 
organization. 



155 

(d) The presidents of sanitary divisions to be classified as 
commissioned officers in the Philippine Health Service. 

(e) That all officers in the Service be employed at full time. 
(/) The schedule of salaries to be as follows: 

President of sanitary division ^2,400 

Surgeon ^ 3,000 

Senior surgeon 3,600 

Medical inspector 4,200 

Senior medical inspector 5,000 

Senior medical inspector and inspector of sanitary district 5,800 

Senior medical inspector and chief of division, one of whom should 

be Assistant Director of Health 7,200 

Director of Health 10,000 

The salaries of noncommissioned officers graduated from the 
'Training School of Sanitation'' should be as follow: 

Assistant sanitary inspector, third class per annum.... WOO 

Assistant sanitary inspector, second class do 720 

Assistant sanitary inspector, first class do 900 

Senior assistant sanitary inspector do 1,000 

Sanitary inspector, third class do 1,200 

Sanitary inspector, second class do 1,500 

Sanitary inspector, first class do 1,800 

Senior sanitary inspector do 2,400 

(g) That the Service furnish free uniforms to noncommis- 
sioned officers. 

2. WITH REFERENCE TO WATER SUPPLIES. 

(a) Introduction and extension of methods of water purifi- 
cation. 

(ft) Stimulation and facilities to communities and municipal 
governments in drilled artesian wells, gravity, hydrant or other 
safe systems of water supply. 

8. WITH REFERENCE TO EXCRETA AND REFUSE DISPOSAL 

(a) Making compulsory the establishment of sanitary dis- 
posal of excreta and refuse in any kind of building, public or 
private, and in streets. 

(6) Elimination within municipal limits of cesspools and 
privies. 

(c) Permitting no building of any kind to be built without 
sanitary facilities. 

(d) Promulgate a law giving power to the Philippine Health 
Service for regulating in the Islands the above provisions. 



156 

4. WITH REFERENCE TO COMMUNICABLE DISEASES. 

(a) Promulgation by the Service of minimum standard for 
the control of nuisances. 

(6) Declaration by the Service of the conditions which shall 
be considered as nuisances. 

(c) Promulgation by the Service of standard of industrial 
hygiene and sanitation of places of employment. 

(d) Standard of dwelling houses for laborers. 

(e) Promulgation of standard methods for scoring the sani- 
tary condition of communities. 



REPORT OF THE DIVISION OF MINDANAO AND SULU. 

[Dr. JACOBO Fajardo, Chief of Division.] 



For the sake of brevity and for other sufficient reasons, it 
seems unnecessary to repeat the matters contained in pre- 
vious reports v^hich should be considered the basis for this 
and subsequent reports. Accordingly, the text of the present 
report is limited as far as possible to the statement of note- 
worthy and significant occurrences during the year. 

I. 

AREA. 

There has been no change in the territorial area of the Divi- 
sion of Mindanao and Sulu. The division embraces all the 
provinces w^ithin the Islands of Mindanao and Sulu. 

II. 

ORGANIZATION. 

All the provinces of the division are organized into sanitary 
divisions. The general provisions of law concerning public 
health have been made applicable to the provinces of the De- 
partment. The Province of Surigao was the last to be organized 
into sanitary divisions. After a great effort in securing phy- 
sicians to be presidents of the sanitary divisions in May last, 
all the positions have been filled and the towns along the Pacific 
coast where the people have never before seen physicians began 
to receive the benefit of the organization; with this organiza- 
tion of the Province of Surigao, it may be said that the coast 
towns of the Island of Mindanao, including the Pacific coast, 
besides those towns in the interior of the Island, are now fairly 
provided with medical assistance. 

III. 

During the year, the number of personnel of the division is 
as follows: 

Physicians 33 

Commissioned officers 16 

Noncommissioned officers 17 

Nurses 41 

Males 26 

Females 15 

Midwives 10 

Dispensary attendant-sanitary inspectors 66 

Sanitary inspectors 51 

Special sanitary inspectors 9 

Total 210 

157 



158 
IV. 

PREVENTABLE COMMUNICABLE DISEASES. 

CHOLERA. 

The cholera epidemic in the Provinces of Agusan, Misamis, 
and Surigao was the continuation of the 1917 outbreak. 

In the Province of Agusan, the last case was registered in 
February and since then till the close of the year the disease 
did not reappear at all in the province. 

The Province of Lanao was infected on May 8, the case being 
one of the sailors of the Kolambugan Lumber Co. On June 2, 
a sailor of an interisland steamer who landed in Kolambugan 
died from cholera. The infection of Kolambugan was evidently 
from the town of Misamis, Misamis. On June 9, the disease 
broke out in the municipal district of Capatagan which lasted up 
to July 16. On September 11, sporadic cases of cholera were re- 
corded in the municipality of Iligan. It is very likely that the in- 
fection was brought by travelers from Initao, Misamis. Again, 
infection from Cagayan, Misamis Province, found its way by 
some traders bound for Taraka, Lanao. Two of them died 
while still on the way. The infection extended as far as Gata, 
Romain, Ganassi, Linok and Madallum. At the close of the 
year, the epidemic was practically placed under control, there 
being registered in January of 1919 but one case and one 
death. 

The Province of Zamboanga was infected in January. The 
first municipality infected was Dipolog. ^Dapitan was the 
second to be infected in the same month. The epidemic abated 
on March 14 when the last case was reported. On June 23, 
the disease broke out in Margosatubig, but the epidemic was, 
like the other epidemics, immediately placed under control and 
had but very few victims to be lamented up to July 6. On 
December 7, a case was discovered in the barrio of Ayala of 
the municipality of Zamboanga. Ayala is the landing place of 
some Moro traders proceeding on vintas (Moro boats) from 
Dumaguete, Cebu, and other Visayan ports. The infection 
spread very rapidly and reached the barrios of Santa Maria, 
Santa Cruz, Tugaga, Tubungan, Talontalon, Guioan, Boalan, 
and Tetuan, besides the poblacion of Zamboanga. At the close 
of the year the epidemic was practically under control. 

Below is shown the consolidated report of cholera during the 
year: 



159 



1 




s 




;as 




►o 


o 




oi 




C 


CO 


c6 


.5:^ 


^ 









&00U3d000rJ<O(Mi-HO 



WM i-H OarH 



OOC<I<X)(M'-trHl-T-ia5»-t.-H 
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Cg (M (M CvJ »-<T-l 



(N lOOlM i«0 itCOtf) 



U 
II 






160 



Cholera statistics, by municipalities. 



Agusan: 

Butuan 

Cabadbaran... 

Talacogon 

Gibuni? 

Simolao 

Wawa-Ojot -_. 
Umayam 

Total 

Bukidnon; 

Tankulan 

Libuna 

Total 

Lanao: 

Kolambugan.- 

Kapatagan 

Iligan 

Taraka 

Romain 

Gata 

Ginassi 

Lenok 

Madallum 

Total 

Misamis: 

Cagayan 

Gingoog 

Initao 

Oroquieta 

Plaridel 

Talisayan 

Jimenez 

Mambajao 

Sagay 

Tapoloan 

Bilingasag .._ 

Baliangao 

Catarman 

Aloran 

Misamis 

Total 

Suriprao 

Surigao 

Dapa 

Cantilan 

Placer 

Gig-aquit 

Hmatuan 

Total 

Zamboangra: 

Zamboanga 

Dapitan 

Dipolog 

Lubungan 

Margisatubig. 
Lubungan 

Total 



i Cases. 


Deaths. 

18 
2 
2 
1 
1 

11 
20 


Mortal- 
ity. 


29 
6 

10 
1 
6 

20 

37 


Per cent. 
















106 


55 


51.88 


7 
8 


4 
3 








15 7 

i ' 


46.66 


3 
25 
10 
17 
5 
5 
2 
6 
5 


3 
9 
6 
10 
5 
5 


3 






















78 i 41 


52.58 


158 
18 
31 

163 

191 
13 

191 

29 

1 

206 

37 

53 

1 

35 

344 


91 
7 
20 
83 

130 
12 

108 
13 
1 
87 
26 
41 

32 

203 
































1,471 


854 


58.05 


14 
287 
149 

13 
138 
154 


11 

248 
78 
13 

107 
88 
















755 545 


72.18 


55 
43 
24 
1 
3 
14 


41 
37 
19 
1 
2 
10 


















140 


110 


78.57 



At the close of the year, of the nine provinces under the 
jurisdiction of this division, only Misamis remained epidemi- 
cally infected. 

As may be seen from the present report, the disease spread 
with the greatest rapidity and prevailed for a longer time in 



161 

the two regularly organized provinces, namely, Surigao and 
Misamis, especially in the latter. This fact is due to the neg- 
ligence on the part of the local authorities in not cooperating 
with the sanitary personnel, and to the lack of a good system 
for the disposal of human excreta. In spite of repeated en- 
deavors to induce the municipal authorities to take up the matter 
of installation of Antipolo system of toilets, both verbally and 
in writing, there are yet some municipilities in Misamis which 
have not adopted the system. The blame should fall on the 
municipal authorities concerned, who paid little or no attention 
to the establishment of proper systems for human waste disposals 

The case of the municipal president of Oroquieta speaks ob- 
viously not only of the negligence on the part of said authority 
but also of his deliberate attempt to be the first in violating 
the law and sanitary regulations. A member of his family 
was attacked with cholera. The patient was living in the same 
house with the president. Instead of reporting the case to the 
health authorities, it was hidden for more than 24 hours until 
a representative of the Health Service discovered it. The 
matter was brought before the provincial board of Misamis, 
but unfortunately nothing was done to administratively punish 
the municipal executive. Similiar cases of concealment of cho- 
lera cases were found in other municipalities of the Province 
of Misamis as reported by the district health officers. 

The towns along the Northern coast of the Island of Min- 
danao are more easily infected on account of their proximity 
to the Visayan provinces and of the constant movement of the 
people from points of the coast of Mindanao to the Visayan 
provinces and viceversa. 

Referring to the infection of the municipality of Zamboanga, 
it has been observed that, as in previous years, the barrio of 
Ayala has always been the place where the first cholera case 
was registered. Many possible factors contribute to explain 
why this is so. (1) Many Moros live in Ayala and its vicinity 
whose main occupation is the trade of a certain dye tree bark 
(tangal). These Moros frequently go to Cebu, stay there for 
days and weeks exposed to infection and then return to Ayala. 
On account of landing from vintas and other larger sailing boats 
on any part of the long shore-line of Ayala, it is quite hard to 
effectively detain and inspect these Moros when returning from 
Cebu before being allowed to land. If these Moros do not 
actually develop cholera they are at least a constant source of 
infection as cholera carriers. 

168426 ^11 



162 

SMALLPOX. 

With the excepticvn of the Provinces of Sulu and Bukidnon, 
all the provinces of this division have been infected with 
smallpox. 

The disease broke out in Cotabato in April in the barrio 
of Ganga, district of Dulauan. The infection undoubtedly 
originated from Bayang, Lanao Province, wherefrom seven 
Maranaos came over the Banisilan-Pikit trail to Ganta. 
Fortunately the disease was quickly placed under control. In 
October the epidemic was already in the wane and at the close 
of the year the province could be pronounced practically free 
from the disease. 

The epidemic of smallpox in the Province of Davao was a 
continuation of the 1917 outbreak. In January, 1918, the seat 
of infection was in the municipalities of Davao, Santa Cruz, 
Guianga, and Samal. In that same month the municipalities 
of Tagum and Pantukan became infected. Successively, the 
infection reached Malita, Sigaboy, and Mati. The epidemic 
was in its acute stage in the month of March, thence it gradually 
began to decline. Only a few isolated cases were registered 
towards the close of the year. 

The smallpox epidemic in Lanao was the continuation of the 
December (1917) outbreak. It would not have spread through- 
out the province were it not for the inactivity or at least the 
weakness of the vaccine virus. The epidemic was in its de- 
clining state in September and at the close of the year only 
very few isolated cases were registered. 

The first case of smallpox in the Province of Misamis was 
discovered in April in the municipality of Mambajao, where a 
girl who had come from Cebu was found suffering from the 
disease. During the same month cases among Moros were 
registered in the mountains of Polut and Liposang. Succes- 
sively, Misamis, Cagayan, Initao, Aloran, Jimenez, Balingasag, 
Plaridel and Tagoloan were infected. 

In June one case of smallpox was registered in the munic- 
ipality of Hinatuan, Surigao, the patient being a native who had 
come from Cebu. Up to the last day of August, 15 cases with 
5 deaths were recorded in Hinatuan. No cases were registered 
in September. In October the disease broke out in Dinagat 
and Placer. Only Surigao and Dinagat remained infected at 
the close of the year. 

The 1917 epidemic of smallpox in Zamboanga continued 
during 1918. During the year the places infected were Zam- 



163 

boanga, Margosatubig, Dapitan, Isabela, Dipolog, Putic, and 
Mercedes. Towards the close of the year only Dapitan and 
Dipolog remained infected. Of the cases registered in the 
municipality of Zamboanga only very few were found in the 
city itself, the rest being in the remote barrios and districts. 
The following tables show the number of cases and deaths 
during the year: 



164 



5^ 



, <*.> vj i^i >j 

COC»«©»Ot-00«£>t-COl>0«0 



0O«0i-H00e0O00»-t«OrST-( 



. iH rH r-t C<1 O >-< r- 



1 1- r-t ?o u5 »-i «£> r- 



iO"<*0 lOtDOi 









^ 






-t CO 00 t- «o <X) 



Tt(M-^Ot>00C0-»»(NO 



'g3^S^°°§5 



<£>T}»eOCaU3TH-^TOU50J 
lOrHeOCXJCOtOCOr-HOO 



<£)C»OOOCO«OT-lrt<COCOt-l:> 



iCOrHOO'-IOilOi-HO 

l> O500'fl<CO 

T-<rH CO 



3 

o 



■ -O ^ lO C3i Tjt 0> 



ii 2j2 I I « £ <u c c 



165 

Smallpox statistics, by municipalities. 



Cotabato: 

Maganoy 

Cotabato 

Parang 

Glan 

Tumbao 

Dulauan 

Calanganan 

Nuling 

Dinaig: .— 

Kidapawan 

Silik , 

Taviran 

Libungan 

Awang 

Peido Pulangi 

Pagalungan 

Buluan 

Total 

Davao: 

Davao 

Samal - 

Pantukan 

Guianga 

Sta. Cruz 

Tagum 

Malita 

Mati 

Sigaboy 

Total 

Lanao: 

Dansalan 

Ganassi 

Ditzaan 

Tugaya 

Tamparan 

Binidayan 

Madamba 

Romain 

Pantar 

Iligan 

Lumbatan 

Watu . 

Munai 

Maguing 

Butig 

Taraka 

Capai 

Kylambugan 

Balut 

Sadoc 

Tuca 

Lumbak...^ 

Bakulud 

Maul 

Sugud 

Gadungin . 

Kialilidan 

Bated 

Marimaut 

Madaya 

Buayan 

Betsaan 

Buntong 

Pindnlunan 

Dilabayan 

Calawa 

Buadiailawan _. 

Disumbing 

Dapan 

Magunayan ._ 

» No report. 



Cases. 


Deaths. 


Mortal- 
ity. 






Per cent. 


115 


19 




543 


521 




116 


16 




265 


63 




483 


41 




2.827 


231 




28 


1 




755 


60 




1,313 


76 




8 


1 




755 


30 




35 







26 


1 




174 


23 




39 


13 




94 


6 




(») 


200 




7.576 


1,302 


10.99 


455 


73 




161 


55 




270 


32 




190 


61 




530 


122 




387 


14 




110 


9 




30 


7 




5 


1 




2.138 


374 


17.94 


112 


9 




187 


15 




8 







268 


19 




6 







256 


23 




19 


5 




36 


4 




20 







80 


9 




19 


1 




7 







. 30 


1 




18 


3 




2 







1 







4 







20 


4 




156 


6 




6 







9 







22 


1 




201 


8 




16 


3 




2 


1 




2 







27 







69 


2 




1 







1 


1 




2 







1 







4 







14 







7 







56 


4 







1 




11 







1 







18 








166 



Smallpox statistics, by municipalities — Continued. 





Cases. Deaths, 


Mortal- 
ity. 


Lanao: — Continued. 

Tubaran 

Malaban^ . 


53 
35 
53 

106 
68 
30 

611 


8 
3 
3 
4 
5 
1 
18 


Per cent. 


Pualas .. . .. -. __. 




Madallum 




Tatarican _- .-- 




Marantau 

Bayang 




Nunungran . 


25 1 2 












Total 


2,700 


164 


6.07 






Misamis: 
Cagayan 


5 

86 
17 


1 
12 
5 




Misamis 




Initao -. - - - 




Aloran 


9 i 2 




Mambajao . _. 


2 

34 
2 



11 





Jimenez.- . . . . _ ._ __ _ 




Tagoloan 




Total 


155 


31 


20.00 


Sulu: 

Siasi -- - 


2 


1 








Total - 


2 


1 


50.50 




1 


Surigrao: 

Surig'ao _. -_ . 


23 
19 

1 
9 


10 
4 
4 

1 




Hinatuan 




Dinai^at 




Placer. 








Total 


52 


19 


30.64 






Zamboangra: 

Zamboangra ._ 


179 
82 
30 
10 
1 
1 
3 
2 


20 
31 
11 


1 
1 





Marg'osatubig^ .. 




GotasCamp-- __ .^- 




Dapitan . _ . 




Isabela ..-. 




Dipologr --- - 




Putik . _ - . ._ 




Mercedes . 








Total ... 


308 


64 


20.77 







The provinces that remained infected at the close of the year 
were Cotabato, Davao, Misamis, Surigao, and Zamboanga. 

The campaign against smallpox has been carried on very ac- 
tively in view of the increment of the epidemic during the year. 
Transportation difficulties, the almost general antagonism of 
the non-Christians to oppose vaccination based on religious 
scruples and ignorance constitute few of the many handicaps 
of the Service in Mindanao and Sulu. Forty-one emergency 
hospitals were established at various times and places during 
the year. 

MALARIA. 

Malaria is a sanitary as well as an economic problem. Being 
the most prevalent disease in this division, it actually hinders 
the development of agricultural regions on account of its ill 
effects on immigrants. This is especially true in Davao where 



167 

abaca is the most important product. The water stored in the 
stalk of the abaca leaf is a breeding place of mosquitoes. 
Besides, the decaying pulp of the abaca trunk and the abundant 
shade afforded by the trees aid in the propagation of mosquitoes 
in the wet soil. This observation may partly explain the en- 
demicity of malaria in Davao, where 900 cases were reported 
during the year. The new immigrants were preferably at- 
tacked and with a higher rate of mortality. In Lanao malaria 
is more prevalent in towns along the border of lake Lanao, 
which forms many fresh wafer swamps, than in those in the 
hinterland. While in Davao the establishment of sanitary bar- 
rios in elevated places cleared of trees will greatly reduce ma- 
laria, in Lanao a widening of the outlet of the lake (Agus River) 
so that its water level is lowered by at least one meter, will 
accomplish the same result. These two undertakings require 
a respectable appropriation, but they are projects well worth 
accomplishing. The liberal distribution of quinine among the 
people was resorted to as a means, indeed not very effective, 
to its control. 

The cases registered in the different dispensaries during the 
year are as follows : 

Cases. 

Agusan 946 

Bukidnon 132 

Cotabato 2,512 

Davao 900 

Lanao 1,670 

Misamis 730 

Sulu 6,460 

Surigao ^ 144 

Zamboanga 1,172 

Total 14,666 

INFLUENZA. 

The first case of influenza was recorded in the Province of 
Sulu on August 3, followed in September by two cases intro- 
duced by ships from Manila, Singapore and Sandakan ; October 
and November saw the acme of the epidemic, attacking the health 
and hospital personnel and a large part of the Philippine Con- 
stabulary force. 

The disease spread to the other provinces of this division 
and in November all of the provinces were practically infected. 
The acme of the epidemic was reached in the latter part of 
November and December. It is presumed that about 90 per 
cent of the total population was attacked. The Province of 



168 

Misamis was the most severely afflicted by the epidemic, 1,354 
deaths having been registered in 12 municipalities. The Prov- 
ince of Agusan follows the Province of Misamis in the greatest 
number of deaths with 521. 

Among the muncipalities, Butuan, Cabadbaran, Dapitan, Di- 
polog, and Lubungan have recorded the highest percentage of 
mortality. Butuan recorded 93 deaths, Cabadbaran 107, Da- 
pitan 117, Dipolog 259 and Lubungan, 88. In the municipal- 
ity of Zamboanga, in spite of the large population, about 25,000, 
a total of only 105 deaths have been recorded. In spite of this, 
generally speaking, it can be said that the people of Mindanao 
and Sulu have been more fortunate than those in other towns 
of the Archipelago for not having many deaths to be lamented. 
The hospitals and dispensaries rendered the most valuable serv- 
ices to the community during the epidemic. 

VENEREAL DISEASES. 

The regular examination and supervision of registered pros- 
titutes have contributed very little to the eradication of venereal 
diseases. If these diseases have spread as they are now, it was 
due to Christian and non-Christian prostitutes whose very low 
standard of living and lack of self-respect had rendered them 
callous to the shame and ignominy of a sentence to prison. Many 
times a Mora streetwalker is caught and sentenced to prison. 
She is imprisoned for a time after which she recurs to the same 
shameful profession. The remedy would seem to be the creation 
of a hospital of mercy where these unfortunates can be kept 
under constant curveillance. Isolation and imprisonment have 
lost to them their power of moral rehabilition. They have to 
be considered as creatures of the state while their standard of 
living and morals is gradually being raised by education of the 
masses. 

The arrival of the prostitutes from Manila also increased the 
incidence of gonorrhea. Out of a total of 180 cases reported in 
the Province of Davao, 126 occurred in the town of Davao. 
Once free from medical supervision, these girls began to spread 
around the province and with them the infection. This remit- 
tance was likened to an intravenous innoculation of the Prov- 
ince of Davao, with pathogenic organisms which spread all over 
its blood vascular system of transportation, and settled and de- 
veloped in numerous foci all over its organism, perhaps never 
again to be rendered free from its effects. 



169 

Davao is especially prone to react to such a remittance because 
of the lack of women, and the use the men make of registered 
prostitutes. Of 1,952 laboratory specimens in Davao, 1,765 were 
uterine discharges from the prostitutes. 

The following table taken from the reports of dispensaries and 
hospital shows the incidence of venereal diseases in the division : 





Gonor- 
rhea. 


Syph- 
ilis. 




Yaws. 


Atrusan _._'.. 


30 
107 
130 

20 

20 
119 

19 


34 


Cotabato 

Davao . _ 


28 
2 
8 
15 
21 
22 


1 


Lanao. 


10 


Misamis 




Sulu . - 


194 


Zamboan^a .-. 


2 






Total-. 


445 


96 


241 



DYSENTERY AND TYPHOID. 

These two diseases go hand in hand, both being water-borne. 
The cases occurred throughout the year sporadically in most 
instances. The remittance of bacillus typhosus and the difficulty 
of proving its presence in the water supply explain the occur- 
rence of the diseases endemically. Perhaps carriers contribute 
the larger part of the source of infection. Unlike a survey for 
intestinal parasites, the search for typhoid carriers is accom- 
panied by very difficult technic. Like cholera, the bacillus ty- 
phosus lodges in the gall bladder from which it emerges 
intermittently and from which it is yet an unsolved scientific 
question to dislodge. While a universal campaign of typhoid 
vaccination, hard and tedious as it is, will greatly reduce the 
virulence of the attack, it does not insure the elimination of 
latent and active carriers. Experience in many American cities 
has shown that a marked reduction of the typhoid death rate 
by a process of chlorination of the water supply can be obtained. 
This process is cheap and practicable. It can be practiced by 
local authorities where a common water supply is available, or 
even by families by means of instructions from the health office. 
The process is simple, and the chlorinated water can be habit- 
uated to by the people. 

Bacillary dysentery has prevailed with preference among Ja- 
panese in Davao. Of a total of 272 cases 165 occurred among 
Japanese. In Japan the Shiga strain prevails, and the most 
preferential incidence among them would seem to show either 
that the Japanese per se enjoy in the tropics a lower degree of 



170 

bodily resistance or that the Shiga strain in the tropics increases 
in virulence. In either case the introduction of the strain in the 
Islands should be avoided as much as possible by proper examina- 
tion and isolation of the immigrants. 

LEPROSY. 

During the vaccination campaign, sanitary inspectors were 
directed to detect lepers also. In Lanao and Sulu leper collec- 
tion was sometimes accompanied by threats of violent opposition. 
Prominent datus were asked to help, and they complied so tact- 
fully that no actual accident happened. 

Below are shown the reported cases and deaths (data for 
cholera, smallpox and malaria given above) : 



171 



COTf ir- i-H 00 tH 05 



OC-OCO lOOOlM 



_J I 

OOfHCO iSP i 






•So 

5 en 



3 CJ 
0,0 



^ 55 



i-HrH CO 



NOOO I 



C- CO CO CO -^ 
Jh Jh CO 



Oi?DOrH(Nr-tgoa 



00(M'<^rHTj<(Mg— J« 






'S 1^ 2 ^ D-2 <U 4) o 

a n a"^ 2 »H M rt,s 
>t>.«.2';f ea «tf a> cJ 



si 

c ^ 

. •*-• 
u o 
o 

■^ CO 

So 



AJq 



0} V 

o o 



B p. 



O 



172 



DISPENSARIES. 

The total number of dispensaries in operation during the year 
was 88, distributed as follows : 

In charge of physician. 

Agusan 

Cotabato 

Davao 

Lanao 

Misamis 

Sulu 

Surigao 

Zamboanga 

In charge of graduate nurse. 



Agusan 
Cotabato 



Davao 

Lanao 

Sulu 

Surigao 

In charge of non-graduates. 

Agusan 

Bukidnon 

Cotabato 

Lanao 

Misamis 

Sulu 

Surigao 



2 

4 
9 
8 

10 
8 
4 

10 



3 Zamboanga 

It will be noted that the number of dispensaries during the 
year is less than the number in 1917. The decrease is caused 
mainly by the resignations of many dispensary attendants, espe- 
cially in the Province of Davao where better opportunities are 
offered on private plantations to men with experience in con- 
ducting dispensaries. These attendants, whenever they find 
better salaries with certain emoluments such as quarters, sub- 
sistence and the ownership of a piece of cultivated land, naturally 
have to retire from the Government service to accept such better 
remunerated offers. 

Below is shown the consolidated report of dispensaries during 
the year : 



Number and diagnosis. 



1. 

2 

3. 

4. 

4a 

5. 

6. 

7. 

8. 

9a. 
10. 
11. 
12. 
13. 
14. 
15. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 



Typhoid fever ._. 

Typhus fever 

Relapsing fever _ 
Malaria : 



Malaria Cachexia. 
Smallpox 

Measles - 



Scarlet fever 

Whooping cough . 
,. Croup . 



Influenza 

Miliary fever 

Asiatic cholera.. 
Cholera nostras . 

Dysentery 

Plague - 



Leprosy 

Erysipelas 

Other epidemic diseases 

Purulent infection and septichaemia. 

Glanders 

Anthrax 



Rabie 

Tetanus 

Mycoses 

Pellagra 

Beriberi 

Tuberculosis of the lungs . 





Treat- 




ment. 


72 


150 


2 


10 


39 


71 


14, 66(> 


25,230 


27 


107 


3.166 


11,291 


182 


705 


1 


3 


314 


868 


1 


1 


5,090 


7,636 


3 


15 


66 


90 


5 


5 


818 


2,135 


5 


11 


40 


446 


13 


27 


2,257 


5,557 


641 


1,683 


2 


9 


18 


114 


2 


8 


6 


44 


19 


94 


6 


33 


408 


855 


361 


867 



173 



Number and diagnosis. 



90. 

91. 

92. 

93. 

94. 

95. 

96. 

97. 

98. 

99. 
100. 
101. 
102. 
103. 
104. 
105. 
106. 
107. 
108. 
109. 
110. 
111. 
113. 
115. 
116. 
117. 
118. 



Acute miliary tuberculosis ... 

Tuberculosis meningitis 

Abdominal tuberculosis 

Pott's disease 

White swelling- 

Tuberculosis of other organs - 
Rickets 



Syphilis 

Gonococcus infection 

Cancer and other malignant tumors of the buccal cavity ..- __ 

Cancer and other malignant tumors of the stomach, and liver 

Cancer and other malignant tumors of the peritoneum, intestines, and rectum 

Cancer and other malignant tumors ot the female genital organs 

Cancer and other malignant tumors of the- breast 

Cancer and other malignant tumors of the skin 

Cancer and other malignant tumors of other organs and of organs not specified 

Other tumors (tumors of the female genital organs excepted) 

Acute rheumatism 

Chronic rheumatism and gout 

Scurvy. 



Diabetes 

Exophthalmic goitre 

Leuchemia 

Anemia chlorosis 

Other general diseases 

Alcoholism (acute or chronic) 

Chronic leaed poisoning 

Other chronic occupational poisonings 

Other chronic poisonings 

Encephalitis 

Simple meningitis 

Locomotor ataxia 

Other diseases of the spinal cord 

Cerebral hemorrhage apoplexy 

Softening of the brain 

Paralysis without specified c*ause 

Genferal paralysis of the insane 

Other forms of mental alienation 

Epilepsy. 



Convulsions (nonpuerperal) . 

Convulsions of infants 

Chorea. 



Neuralgia and neuritis 

Other diseases of the nervous system 

Diseases of the eye and their annexa 

Diseases of the ears ._- 

Pericarditis 

Acute endocarditis 

Organic diseases of the heart ._. 

Angina pectoris 

Diseases of the arteries, atheroma, aneurism, etc 

Embolism and thrombosis 

Diseases of the veins (varices, haemorrhoids, phlebitis, etc). 

Diseases of the Ivmphatic system (lymphangitis, etc.) 

Hemorrhage, and other diseases of the circulatory system .__ 

Diseases of the nasal fossae 

Diseases of the larynx 

Diseases of the thyreoid body 

Acute bronchitis 

Chronic bronchitis 

Broncho-pneumonia 

Pneumonia 

Pleurisy . 



Pulmonary congestion, pulmonary apoplexy . 
Gangrene of the lungs 

Asthma. 



Pulmonary emphysema 

Other diseases of the respiratory system (tuberculosis excepted) 

Diseases of the mouth and annexa 

Diseases of the pharynx 

Diseases of the aesophagus 

Ulcer of the stomach 

Other diseases of the stomach (cancer excepted) 

Diarrhoea and enteritis (under 2 years) 

Diarrhoea and enteritis (2 years and over) 

Ankylostomiasis 

Intestinal parasites 

Appendicitis and typhlitis 

Hernias, intestinal obstructions 

Other diseases of the intestines _-_ 

Acute yellow atrophy of the liver 

Cirrhosis of the liver 

Other diseases of the liver 

Diseases of the spleen 

Simple peritonitis (non-puerperal) 

Other diseases of the digestive system (cancer and tuberculosis excepted) . 



1 Cases. 

! 


' Treat- 
ment. 


2 


14 


2 


4 


1 


9 


6 


6 


22 


183 


82 


223 


5 


12 


73 


599 


262 


1,890 


3 


5 


2 


24 


5 


26 


4 


17 


3 


4 


28 


82 


15 


34 


30 


150 


430 


1,306 


62 


124 


2 


4 


7 


19 


1 


1 


9 


67 


347 


1,184 


183 


' 862 


18 


28 


1 


6 


1 


1 


9 


28 


8 


14 


16 


20 


2 


4 


4 


10 


6 


6 


3 


14 


7 


20 


7 


68 


9 


12 


8 


26 


8 


13 


61 


79 


2 


2 


738 


1,091 


110 


167 


1,833 


4.991 


420 


1,307 


6 


7 


41 


78 


39 


93 


12 


16 


16 


31 


1 


9 


8 


12 


37 


154 


25 


76 


263 


530 


50 


119 


3 


5 


2,052 


3,316 


533 


841 


38 


107 


37 


130 


31 


95 


3 


7 


1 


1 


169 


286 


4 


6 


325 


601 


1,033 


1,867 


122 


174 


9 


15 


77 


169 


3,055 


4,726 


338 


573 


586 


1.170 


16 


132 


5,333 


6,348 


12 


30 


52 


228 


620 


841 


5 


29 


1 


1 


16 


32 


18 


43 


10 


28 


728 


1.141 



174 



Number and diagnoeis. 



119. Acute nephritis _.. 

120. Bright's disease 

122. Other diseases of the kidneys and annexa 

123. Calculi of the urinary passage 

124. Diseases of the bladder 

125. Other diseases of the urethra, urinary abscess, etc _. 

126. Diseases of the prostate 

127. Nonvenereal diseases of the male genital organs.. 

128. Uterine hemorrhage (nonpuerperal) ... 

129. Uterine tumor (noncancerous) 

130. Other diseases of the uterus 

131. Cysts and other tumors of the ovary 

132. Salpingitis and other diseases of the female genital organs 

133. Nonpuerperal diseases of the breast (cancer excepted) 

134. Accidents of pregnancy 

135. Puerperal hemorrhage 

136. Other accidents of labor ___ 

137. Puerperal septichaemia 

138. Puerperal albuminaria and convulsions 

139. Puerperal phlegmasia alba dolens, embolia, sudden death 

140. Diseases following childbirth (not otherwise defined) 

141. Puerperal diseases of the breast .._ 

142. Gangrene 

143. Furuncle 

144,' Acute abscess 

145. Other diseases of the skin and annexa 

146. Diseases of the bones (tuberculosis excepted) 

147. Diseases of the joints (tuberculosis and rheumatism excepted) 

148. Amputation "_ 

149. Other diseases of the organs of locomotion 

150. Congenital malformation (stillbirths not included) 

151. Congenital debility, icterus and sclerema 

152. Other diseases peculiar to early infancy 

153. Lack of care . 

154. Senility 

155. Suicide by poison 

158. Suicide dy drowning 

160. Suicide by cutting or piercing instruments 

161. Suicide by jumping from a high place 

162. Suicide by crushing 

163. Other suicides 

164. Poisoning by food 

165a. Venomous bites and stings 

166. Conflagration 

167. Burns (conflagration excepted) 

168. Absorption of deleterious gases (conflagration excepted) 

169. Accidental drowning 

170. Traumatism by firearms 

171. Traumatism by cutting or piercing instruments 

172. Traumatism by fall .* 

174. Traumatism by machines 

175. Traumatism by other crushing (vehicles, railways, landslides, etc.) 

176. Injuries by animals 

177. Starvation 

178. Excessive cold , 

179. Effects of heat 

182. Homicide by firearms 

183. Homicide by cutting or piercing instruments 

184. Homicide by other means 

185. Fractures (cause not specified) 

186. Other external violence - _. 

187. Ill-defined organic diseases 

188. Sudden death 

189. Cause of death not specified or ill-defined 



Cases. 



70 

24 

57 

4 

5 

1 

146 

3 

62 

952 

1.054 

14. 645 

16 

28 

6 

162 

8 

17 

41 

10 

9 

3 

1 

33 

9 

3 

20 

9 

52 

25 

240 

2 

1 

148 

2,950 

63 

18 

120 

77 

1 

5 

14 

3 

4 

7 

47 

2.248 

153 

5 

2,103 



Total - 74,842 



175 



Summary by districts. 



I Cases. 



Agusan 1 3,512 



Bukidnon. 

Cotabato 

Davao 

Lanao 

Misamis 

Sulu 

Surigao 

Zamboanga 

Total . 



1,017 

22, 045 

3,127 

7,745 

4,007 

25.219 

714 

7.456 



74, 842 



Treat- 
ments. 

6,625 
1,017 
63.102 
10, 937 
14, 854 
8, 020 
45, 875 
714 
14,352 



164,496 



VI. 



HOSPITAIiS. 



During the year the following hospitals were in operation in 
this division, namely: The Butuan Hospital in Butuan, Agusan; 
Cotabato Public Hospital, Cotabato, Cotabato; Mati Hospital, 
Mati, Davao; Lanao Public Hospital, Dansalan, Lanao; Misamis 
Provincial Hospital, Cagayan, Misamis; Sulu Public Hospital, 
Jolo, Sulu; Rizal Memorial Hospital, Dapitan, Zamboanga; and 
Zamboanga General Hospital, Zamboanga, Zamboanga. The 
Mati and Misamis hospitals are only provisional. The Zam- 
boanga General Hospital was formally inaugurated on September 
1, 1918. Patients began to be admitted on the following day. 
A concrete hospital building is now under construction in each 
of the municipalities of Davao, Davao, and Butuan, Agusan. 



176 



BUTUAN HOSPITAL. 

Hospital cases. 



Number and diagnosis. 



4. Malaria 

10. Influenza..- 

14. Dysentery _ 

17. Leprosy 

18. Erysipelas 

27. Beriberi 

31. Abdominal tuberculosis 

34. Tuberculosis of other organs 

46. Other tumors (tumors of the femalegenital organs 

excepted) 

47. Acute articular rheumatism 

48. Chronic rheumatism and gout 

54. Anaemia chlorosis 

61a. Meningitis, cerebro-spinal, epidemic 

64. Cerebral hemorrhage apoplexy 

68. Other forms of mental alienation 

69. Epilepsy 

72. Chorea 

73. Neuralgia and neuritis 

75. Diseases of the eyes and their annexa ! 

79. Organic diseases j 

83. Diseases of the veins (varices, haemorrhoids, phle- i 

bitis, etc.) 1 

85. Haemorrhage, and other diseases of the circulatory . 

system 1 

89. Acute bronchitis | 

91. Broncho-pneumonia j 

92. Pneumonia 1 

93. Pleurisy.- 1 

103. Other diseases of the stomach (cancer excepted) .--i 

104. Diarrhoea and enteritis (under 2 years) 

105. Diarrhoea and enteritis (2 years and over) 

106. Ankylostomiasis 

107. Intestinal parasites 

109. Hernia, intestinal obstructions 

110. Other diseases of the intestines '' 

113. Cirrhosis of the liver I 

115. Other diseases of the liver-. 

119. Acute nephritis 

125. Other diseases of the urethra, urinary abscess, etc. 

127. Nonvenereal diseases of the male genital organs 

136. Other accidents of labor .-. 

142. Gangrene 

143. Furuncle 

144. Acute abscess 

145. Other diseases of the skin and annexa 

147. Diseases of the joints (tuberculosis and rheuma- 

tism excepted) 

148. Amputation 

151. Congenital debility, icterus and sclerema 

164. Poisoning by food 

175. Traumatism by other crushing (vehicles, railways, 

landslides, etc.) 

186. Other external violence 

Total 



70 
16 

7 
1 
1 
1 
1 
5 



20 



15 
7 
1 
1 
1 



60 



177 



Summary and mieoellaneous. 

Total number of patients admitted during the year 191 

Clinics : 

Dental 2 

Medical 157 

Surgical 28 

Obstetrical 1 

Eye, ear, nose, and throat 3 

Nationalities of patients: 
Filipinos — 

Christians 190 

Non-Christians 

Americans 1 

Sex of patients: 

Male 168 

Female 23 

Class of service: 

Charity 103 



2 
32 
54 



Government free 

Private pay 

Government pay 

Official pay 

Operations performed: 

Major^Filipinos (Christian) 7 

Charity 4 

Private pay 3 

Minor — Filipino (Christian) 175 

Charity 29 

Private pay 146 

Prescriptions filled: 

Charity 241 

Private pay 2,399 

Number of outside calls made by the medical hospital staff 309 

Number of visits by out-patients 2,463 

Average visits of out-patients per day 6.74 

COTABATO HOSPITAL. 

Hospital Cases, 



Number and diagnoeis. 



1. Typhoid fever 

4. Malaria 

5. Smallpox 

8. Whoopingr cough 

10. Influenza 

14. Dysentery 

19. Other epidemic diseases 

20. Purulent infection and septichsemia, 
24. Tetanus 

27. Beriberi _ 

28. Tuberculosis of the lungs 

31. Abdominal tuberculosis. 

33. White swelling 









1 
10 



168426- 



-12 



178 



Cotabato Hospital — Continued. 



Number and diagnosis. 


1. 
15 


1 
g 

< 


i 

2 

a 
O 


1 


-2 
5 


Q 


ti 

c 
'c 

S 


34. Tuberculosis of other organs _ 




3 
2 

8 

1 

1 
1 

2 
2 
2 

1 
1 
4 
7 
3 
3 
4 
2 

1 

3 

1 

1 
7 
5 
5 
3 
1 
2 
2 
14 
4 
1 
8 
4 
1 
2 


2 


3 
3 


3 
2 
9 

1 

1 






37. Syphilis 








38. Gonococcus infection ... 


1 






39. Cancer and other malignant tumors of the buccal 
cavity 


1 
2 


1 

1 
2 

4 






42. Cancer and other malignant tumors of the female 
genital organs 








44. Cancer and other malignant tumors of the skin 






1 


46. Other tumors (tumors of the female genital organs 
excepted) 




2 
3 
1 
1 
1 
4 
7 
3 
3 
2 
2 

1 

3 

1 
1 
7 
1 
4 
3 
1 
3 
2 
14 
2 
1 
7 
4 
1 
3 
1 
1 
2 

'""2' 
1 
1 
1 
5 






47. Acute articular rheumatism 


1 






54. Anemia chlorosis _. ._ 










1 


56. Alcoholism (acute or chronic) 








59. Other chronic poisonings I . 










73. Neuralgia and neuritis _. ._ . 1 










74. Other diseases of the nervous system i-. 










75. Diseases of the eyes and their annexa ! 


-____. 


3 
3 






76. Diseases of the ears _. _ .. 








79. Organic diseases of the heart 




2 




81. Diseases of the arteries, atheroma, aneurysm, etc. 











83. Diseases of the veins (varices hemorrhoids, phleb- 
itis, etc.) 


1 
2 


1 
4 






84. Diseases of the lymphatic system (lymphangitis, 
etc.) 








85. Hiemorrhage, and other diseases of the circulatory 
system.. 








86. Diseases of the nassal fossae... 




1 




89. Acute bronchitis . _ 










91. Broncho-pneumonia. ... 






...... 


K 


4 




92. Pneumonia.. 




1 


93. Pleurisy _. 






%. Asthma 








99. Diseases of the mouth and annexa 


2 


2 


2 




1 


100. Diseases of the pharynx 




103. Other diseases of the stomach (cancer excepted) 












104. Diarrhoea and enteritis (under 2 years) 








1 


1 


105. Diarrhoea and enteritis (2 years and over) 








106. Ankylostomiasis _ . 








1 


107. Intestinal parasites ._ . ... 








108. Appendicitis and typhlitis __. 


1 
2 


1 

7 






109. Hernia, intestinal obstruction . 


1 
1 






110. Other diseases of the intestines _. 






111. Acute yellow atrophy of the liver . ... 


1 
2 
2 
2 
1 
1 
1 
4 
1 
2 

2 
1 
3 

13 
1 

13 
3 
1 










115. Other diseases of the liver ... 








""2 




120. Bright's disease 




1 


1 




123. Calculi of the urinary passages 






124. Diseases of the bladder . 




1 
1 


1 

1 






125. Other diseases of the urethra, urinary abscess, etc . 








126. Diseases of the postrate 






127. Nonvenereal diseases of the male genital organs 


1 


2 


6 






129. Uterine tumor (noncancerous) *. 


1 






130. Other diseases of the uterus .__ 




2 
2 


4 
2 


2 

\ 

3 
13 

1 

13 
4 
1 






133. Nonnuerperal diseases of the breast (cancer excep- 
ted) 









134. Accidents of pregnancy 








135. Puerperal hemorrhage 




1 
13 


4 
11 

1 
17 

4 

2 

1 

7 
4 






136. Other accidents of labor 


1 




1 


143. Furuncle 




144. Acute abscess _ . 








145. Other diseases of the skin and annexa 


1 






146. Diseases of the bones (tuberculosis excepted) 






147. Diseases of the joints (tuberculosis and rheum- 
atism excepted) _ 








149. Other diseases of the organs of locomotion 




6 
3 
1 
1 
3 

1 

1 
7 


3 

1 


6 
4 






150. Congenital malformations (stillbirths not included). 


1 






151. Congenital debility, icterus and sclarema 


1 




167. Burns (conflagrations excepted) 




""T 

1 

1 

2 


2 
4 

1 
4 
8 


1 
3 

1 
2 
6 




171. Traumatism (by cutting or piercing instruments) .. 








175. Traumatism by other crushing (vehicles, railways, 
landslides, etc.) _ 








185. Fractures (cause not specified) . 


1 






186. Other external violence _ 




1 








Total 


15 


339 


52 


137 


316 


17 


21 







179 

Summary and Miscellaneous. 

Total number of patients admitted during the year 339 

Clinics. 

Dental 

Medical 232 

Surgical 84 

Obstetrical 16 

Eye, ear, nose, and throat 7 

Nationalities of patients : 
Filipinos — 

Christians 253 

Non-Christians : 63 

Americans 8 

Europeans 2 

Chinese 12 

Asiatics 1 

Sex of patients: 

Males 212 

Females 127 

Class of service: 

Charity 254 

Private pay 43 

Government pay 42 

Operations performed: 
Minor — 

Filipino (Christian) 106 

Filipino (non-Christian) 43 

Europeans 1 

Chinese 3 

Major — 

Filipinos (Christian) 9 

Filipinos (non-Christian) 2 

Americans 1 

Operations performed: 
Minor — 

Charity 127 

Private pay 25 

Government pay 1 

Major — 

Charity 9 

Government pay 2 

Private pay 1 

Prescriptions filled: 

Charity 3»'^6^ 

Government free 148 

Government pay 1^2 

Private pay 670 

Number of outside calls made by the medical hospital staff 170 

Number of visits by out-patients — 4,911 

Average visits of out-patients per day 13.45 



180 

Statement of hospital accounts. 

Debit. Credit. 

Allowance for patients ^2,232.16 

Allowance for personnel 1,550.52 

Expenditures for subsistence of patients and personnel ^2,970.33 

Collections 4,075.87 

Total 2,970.33 7,858.55 

Balance 4,888.22 

LANAO PUBLIC HOSPITAL. 
Hospital cases. 



1. 

4. 

5. 

8. 
10. 
14. 
18. 
19. 
20. 
24. 
27. 
28, 
31. 
34. 
37. 
38. 
45. 



47. 
48. 
51. 
54. 
55. 
56. 
64. 
68. 
69. 
72. 
73. 
74. 
75. 
76. 
79. 
80. 
81. 
83. 

84. 



90. 

91. 

92. 

93. 

96. 

99. 
100. 
103. 
104. 
105. 
106. 
107. 
108. 
109. 



Number and diaffnosis. 


bop. 

B 


1 

s 

< 


i 
% 

O 


1 


i 

u 
Q 

5 
114 

16 
9 

43 

23 
1 

14 

14 
3 
4 

35 
1 
2 
9 

15 

1 

4 
5 
2 
2 

35 
1 
2 
2 
5 
1 
1 
5 
5 

19 
4 
4 
1 
2 

6 

8 
11 
50 

6 
18 
11 

3 

2 

9 
28 
36 

3 


i 


bo 

C 

*£ 
"5 
£ 

03 


Typhoid fever ... 


9 
119 

16 
9 

44 

23 
2 

14 

14 
3 
4 

35 
2 
2 
8 

15 

1 

4 
5 
2 

1 
40 
1 
2 

1 

i 

5 
5 
15 

4 
4 
1 
2 

3 

8 

11 

50 

6 

20 

13 

3 

2 

9 

29 

36 

3 

1 

52 

178 

7 

5 




3 


1 


Malaria 


1 






6 


Smallpox 


i 






Whooping cough 

Influenza __ . 












-__._. 


1 


Dysentery. .__. . . 


1 








Erysipelas .. . 


1 




1 


Other epidemic diseases 




1 



95 

87 




Purulent infection and septichaemia _.. 

Tetanus. ... 












Beriberi 












Tuberculosis of the lungs. . 


1 






-.-.-. 


I 


Abdominal tuberculosis 


1 






Tuberculosis of other organs 






Syphilis ._ 


1 




5 






Conococus infection _ 






Cancer and other malignan tumors of other organs 
and of organs not specified __ _. 












Other tumors (tumors of the female genital organs 
excepted) 

Acute articular rheumatism 


1 


4 


27 


1 


Chronic rheumatism and gout 













Exothalmic Goitre 


1 
1 




3 






Anaemia, chlorosis 




6 


Other general diseases 




















Cerebral hemorrhage apoplexy 


1 










Other forms of mental alienation 










Epilepsy 












Chorea 












Neuralgia and neuritis . .. __ 
























Diseases of the eyes and their annexa 


4 


6 


26 






DiseastrS of the ears 






Organic diseases of the heart 












Angina pectoris 












Diseases of the arteries atheroma aneurism etc 


3 










Diseasea of the veins (varices, hemorrhoids, pleb- 
itis, etc 


1 
1 
2 


8 
8 






Diseases of the lymphatic system (lympangitis, etc.) . 
Diseases of the nasal fossae 










Acute bronchitis 








Chronic bronchitis 












Broncho-pneumonia 








1 
1 


1 


Pneumonia 


1 






2 


Pleurisy 








Asthma.. .. .. . 












Diseases of the nmouth and annexa 




6 
17 


16 






Diseases of the pharynx _ 


1 




2 


Other diseases of the stomach (cancer excepted) 




Diarrhoea and enteriti s (under 2 years) 

Diarrhoea and enteritis (2 years and over) 














1 




Ankylostomiasis 1 


1 






53 

178 

8 

5 




Intestinal parasites -. . . . 








Appendicitis and typhlitis . 


2 


5 
3 


43 
11 


1 


Hernia, intestinal obstructions 







181 
Lanao Public Hospital — Continued. 



Number and diagnosis. 



110. Other diseases of the iutestines 

114. Biliary calculi 

115. Other diseases of the liver 

119. Acute nephritis 

120. Bright's disease 

123. Calculi of the urinary passages . 

124. Diseases of the bladder 

125. Other diseases of the urethra, urinary abscess, etc 

126. Diseases of the prostate 

127. Nonvenereal diseases of the genital male organs _. 

129. Uterine Tumor (noncancerous) ._ 

180. Other diseases of the uterus 

131. Cysts and other tumors the ovary 

132. Salpingitis and other diseases of the female genital 

organs 

134. Accidents of pregnancy 

136. Other accidents of labor 

137. Puerperal septichaemia 

138. Puerperal albuminaria and convulsions 

140. Following childbirth (not otherwise defined) 

142. Gangrene 

143. Furuncle 

144. Acute abscess 

145. Other diseases of the skin and annexa 

146. Diseases of the bones (tuberculosis excepted) 

149. Other diseases of the organs of locomotion 

151. Congenital debility, icterus and sclerema 

152. Other diseases peculiar to early infancy 

167. Burns (conflagrations excepted) 

170. Traumatism by firearms 

171. Traumatism by cutting or piercing instruments 

185 Fractures (cause not specified) 

186. Other external violence 



11 



Total . 



29 1,080 



i 

2 


i 


1 






- 


"' 


Q 


4 






1 






7 






3 






6 


1 


8 


2 






7 
1 


. 





1 



30 



27 



654 1, 



Summary and Miscellaneous. 

Total number of patients admitted during the year 751 

Clinics : 

Medical 879 

Surgical 124 

Eye, ear, nose and throat 46 

Obstetrical 26 

Dental 4 

Nationality of patients : 
Filipinos — 

Christians 606 

Non-Christians 97 

Americans 30 

Chinese 7 

Japanese 9 

Europeans 2 

Sex of patients : 

Males 470 

Females 281 



182 

Summary and Miscellaneous — Continued. 

Class of service; 

Charity 440 

Government free 121 

Private pay 64 

Government pay 126 

Operations performed: 
Minor — 

Filipinos (Christians) 94 

Filipinos (non-Christians) 6 

Americans .— 2 

Japanese 1 

Europeans — . 1 

Major — 

Filipinos (Christians) 13 

Americans 1 

Operations performed: 
Minor — 

Charity 78 

Government free 12 ♦ 

Private pay 14 

Major — 

Charity 10 

Private pay 2 

Government free 2 

Prescriptions filled: 

Charity 828 

Government free 159 

Private pay 53 

Number of outside calls made by the hospital medical staff 51 

Number of visits by out-patients 1,401 

Average visits of out-patients per day 3.83 

Statements of Hospital Accounts. 

Debit. Credit. 

Allowance for patients ^3,480.44 

Allowance for personnel 2,285.93 

Expenditures for subsistence of patients and personnel 1^=4,344.52 

Collections 3,686.92 

Total 4,344.52 9,653.29 

Balance 5,308.77 



183 



MISAMIS PUBLIC HOSPITAL. 
Hospital cases. 



Number and diagnosis. 


11 


i 

1 


1 

a 
O 


.s 

aa 

P 


i 

1 

5 


5 


■5 


4. Malaria 


14 
61 
2 
1 
1 
4 
1 
2 
1 
2 
1 
2 
1 
1 
1 
2 
2 
1 
9 
2 
1 
4 
4 
2 
3 




12 

' 58 
2 
1 
1 
2 
1 
2 
1 
2 
1 
2 
1 
1 


1 
3 


1 


10. Influenza __ 










14. Dysentery 




""l 


""15" 

1 




18. E ry si pelas 








22. Anthrax... . . . 








27. Beriberi 




1 


1 


37. Syphilis 




'"ie 


37 
2 
41 
16 
1 




38. Gonococcus infection .. 








73. Neuralgia and neuritis.. 








75. Diseases of the eyes and their annexa ._ . 








76. Diseases of the ears 








90. Chronic bronchitis _ 








92. Pneumonia _. . 












95. Gangrene of the lungs 












104. Diarrhoea and enteritis (under two years) 










1 


106. Ankylostomiasis __ _ __ ._ 








2 
2 

1 
9 
2 

4 
2 
3 






107. Intestinal parasites 












110. Other diseases of the intestines 




i 

4 
2 


18 

231 

7 

2 

285 

7 

14 

66 






144. Acute «bscess 






14i. Other diseases of the skin and annexa 




-..--. 




167. Burns (conflagrations exepted) 






171. Traumatism by cutting or piercing instruments 






172. Traumatism by fill 






174. Traumatism by machines . 








186. Other external violence -_ .- 















Total 




125 


26 


742 


116 


6 3 











Summary and Miscellaneous. 

Total number of patients admitted during the year 125 

Clinics : 

Medical 35 

Surgical 14 

Nationality of patients: 

Filipinos (Christians) 125 

Sex of patients: 

Males 114 

Females 11 

Class of service: 

Charity 24 

Government pay 15 

Government free 55 

Private pay 31 

Operations performed: 
Minor — 

Filipinos (Christians) 1 

Operations performed: 
Minor — 

Private pay 1 

Number of outside calls made by hospital medical staff 20 



184 

SULU PUBLIC HOSPITAL. 
Hospital cases. 



Number and diagnosiB. 



89. 

91. 

92. 

93, 

94. 

96. 

99. 
100. 
102. 
103. 
104. 
106. 
107. 
108. 
109. 
110. 
115. 
116. 
117. 
119. 
120. 
122. 
123. 
124. 
125, 
127. 
130. 
131. 
182. 

134. 
136. 
137. 
138. 
140. 



Typhoid fevea* 

Malaria 

Measles 

Influenza 

Dysentery 

Other epidemic diseases 

Purulent infection 

Tetanus 

Beriberi 

Tuberculosis of the lungs 

White swelling 

Tuberculosis of other organs 

Syphilis 

Gonococcus infection 

Cancer and other malignant tumors of the peri- 

toneeum, intestines, rectum --_ 

Other tumors (tumors of the female genital organs 

excepted) 

Acute articular rheumatism 

Chronic rheumatism and gout 

Other general diseases 

Alcoholism (acute or chronic) 

Other chronic poisonings 

Simple meningitis 

Cerebral hemorrhage apoplexi 

Epilepsi 

Chorea . 

Neuralgia and neuritis 

Other diseases of the nervous system 

Diseases of the eyes and their annexa 

Diseases of the ears 

Pericarditis 

Organic diseases of the heart 

Diseases of the veins (verices hemorrhoids) 

Diseases of the lymphatic system (lymphangi- 
tis, etc.) 

Diseases of the nasal fossae 

Diseases of the thyroid body 

Acute bronchitis 

Broncho-pneumonia 

Pneumonia 

Pleurisy 

Pulmonary congestion, pulmonary apoplexi 

Asthma 

Diseases of the mouth and annexa 

Diseases of the pharynx 

Ulcer of the stomach 

Other diseases of the stomach (cancer excepted) __. 

Diarrhoea and enteritis (under 2 years) 

Ankylostomiasis 

Intestinal parasites 

Appendicitis and typhlitis 

Hernia, intestinal obstructions 

Other diseases of the intestines 

Other diseases of the liver 

Diseases of the spleen ___ 

Simple peritonitis (nonpuerperal) . _. 

Acute nephritis 

Bright's diseases __. 

Other diseases of the kidneys and annexa .._ _. 

Calculi of the urinary passages 

Diseases of the bladder 

Other diseases of the urethra, urinary abscess 

Nonvenereal diseases of the male genital organs 

Other diseases of the uterus 

Cysts and other tumors of the ovary 

Salphingitis and other diseases of the f^nalft sren- 

ital organs 

Accidents of pregnancy 

Other accidents of labor __. 

Puerperal septichaemia 

Puerperal albuminaria and convulsions 

Following childbirth (not otherwise defined) 



o 



SiS 



I j I 



53 ! 

5 I 



40 






1 

10 
12 
8 


9 i 42 

; 


1 





1 




?, 




? 


|_. ___ 


3 
1 


2 4 


1 




15 




?, 




4 
3 

1 
?, 


1 ! 15 

2 ; 10 
1 1 


2 

6 
3 


7 

2 25 


1 
?0 


1 


15 


n 






14 






?, 






?, 






8 






? 






4 


.-_ 




3 






21 
15 





6 


1 






5 






13 
1 


13 


137 


•3 
4 
1 
2 
5 


3 

1 

1 


32 
34 


1 






1 






? 






1 






?, 






4 

7 


3 



66 


2 

6 
6 
67 
3 
1 


2 

2 
1 

"l 


24 

38 

5 

236 

18 


?. 







Q 
— ... 


j 

be 
C 

'5 

1 
3 


1 


1 






1 






3 
























1 






















1 





























1 
















1 




4 




























2 




















1 




1 
1 











1 
























1 
2 











185 



Sulu Public Hospital — Continued. 



Number and diagnosis. 









I i 'i 



143. Furuncle 

144. Acute abscess 

145. Other diseases of the skin and annexa 

146. Diseases of the bones (tuberculosis excepted) 

149. Other diseases of the organs of locomotion 

150. Congenital malformations (stillbirth not included) . 

161. Congenital debility, icterus and sclerema . .. 

165a. Venomous bites and stings 

165b. Other acute poisonings 

167. Burns (conflagration excepted) 

170. Traumatism by firearms 

171. Traumatism by cutting or piercing instruments 

175. Traumatism by other crushing vehicles, railways, 

landslides, etc.) 

183, Homicide by cutting or piercing instruments 

185. Fractures (cause not specified) 

185. Other external violence 



Total. 



4 I 

lb I. 

17 j 
4 1 

1 1. 

2 I, 
2 I 

2 I 

3 I 

7 j 

7 i 
7 I 
6 I 

18 1 



\ 


181 
20 


5 


28 












...... 


17 
101 
60 




3 


308 
16 
131 



10 : 721 j 67 11,756 



1 I- 



Summary and Miscellaneous. 

Total number of patients admitted during the year 721 

Clinics : 

Medical 351 

Surgical 1^^ 

Eye, ear, nose and throat 14 

Obstetrical 48 

Genito-urinary 40 

Pediatrics - • 130 

Nationality of patients: 
Filipinos — 

Christians 420 

Non-Christians 221 

Americans ^ 

Chinese 39 

Japanese 1^ 

Europeans 1 

Others 1^ 

Sex of patients : 

Males ; 48^ 

Females 241 

Class of service: 

Charity 394 

Government pay 211 

11 R 

Private pay ^^^ 



186 

Summary and Miscellaneous — Continued. 
Operations performed: 
Minor — 

Filipinos (Christians) 128 

Filipinos (non-Christians) 225 

Americans 8 

Chinese 36 

Japanese 8 

Major — 

Filipinos (Christians) 14 

Filipinos (non-Christians) 4 

Chinese 1 

Others 1 

Operations performed: 
Minor — 

Charity 296 

Government pay 54 

Private pay 55 

Major — 

Charity 7 

Government pay 11 

Private pay 2 

Prescriptions filled: 

Charity 1997 

Government pay 1162 

Private pay - 933 

Number of outside calls made by the hospital medical staff 192 

Number of visits by out-patients 16,682 

Average visits of out-patients per day 45.70 

Statements of Hospital Accounts. 

Debit. Credit. 

Allowance for patients ^5,031.83 

Allowance for personnel 1,919.71 

Expenditures for subsistence of patients and personnel P4,947.03 

Collections 7,509.^2 



Total 4,947.03 14,461.06 



Balance 9,514.03 



ZAMBOANGA GENERAL HOSPITAL. 
Hospital cases. 





s 
















it 














' 


boo. 






. 


" y> 




(« 


Number and diagnosis. 


•1! 


1 


2 


? 






'S 




CO m 




5 




M 




a 




6iS 


s 


^ 


« 


^ 


y> 


B 




V 


^3 


p< 








V 




« 


< 


o 


Q 


Q 


Q 


tf 


1. Tvnhoid fever 




3 
9 
1 








2 


1 


4. Malaria 








7 


2 


6. Smallpox 






10. Infiuenz** . . ._ 


__ 


89 

27 

1 






85 
14 
1 


""is" 


4 


12. Asiatic cholera 








14. Dysentery 








19. Other epidemic diseases 


3 




25 


3 







187 



Zamboanga General Hospital — Continued. 



Number and diagnosis. 



20. 
24. 

27. 
28. 
31. 
34. 
38. 
40. 



85. 



90. 

92. 

93. 

96. 

99. 
100. 
102. 
103. 
104. 
105. 
106. 
107. 
108. 
109. 
110. 
117. 
119. 
122. 
124 
127. 
130. 
132. 

m. 

134. 
135. 
136. 
137. 
140. 
143. 
144. 
145. 
146. 
147. 

150 
164. 
167. 
171. 
172. 
175. 

186. 
187. 



Sfft 






Purulent infection and septichaemia 

Tetanus -- 

Beriberi 

Tuberculosis of the lungs , 

Ab lominal tuberculosis 

Tuberculosis of other organs.- 

Gonoc ecus infection 

Cancer and other malignant tumors of the stomach 

and liver --- 

Chronic rheumatism and gout 

Diabetes 

Other diseases of the spinal cord 

Paralysis without specified cause 

Other forms of mental alienation -.. 

Neuralgia and neuritis 

Other diseases of the nervous system 

Diseases of the eyes and their annexa 

D seases of the ears 

Acute endocarditis -- 

Organic diseases of the heart 

Diseases of the veins (varices, haemorrhoids, phleb- 
itis, etc.) 

Diseases of the lymphatic system (lymphangi- 
tis, etc ) 

Haemorrhage, and other diseases of the circula- 
tory system 

Acute bronchitis --. 

Chronic bronchitis 

Pneumonia 

Pleurisy 

Asthma 

Diseases of the mouth and annexa -.. 

Diseases of the pharynx 

Ulcer of the stomach 

Other diseases of the stomach (cancer excepted) .. 

Diarrhoea and enteritis (under 2 years) 

Diarrhoea and enteritis (2 years and over) .._ _. 

Ankylostomiasis .._ 

Intestinal parasites 

Appendicitis and typhlitis 

Hernia, intestinal obstruction 

Other diseases of the intestines 

Simple peritonitis (nonpuerperal) 

Acute nephritis 

Other diseases of the kidneys and annexa 

Diseases of the bladder 

Nonvenereal diseases of the male genital organs ___ 

Other diseases of the uterus 

Sulpingitis and other diseases of the female organs 

Nonp lerperal diseases of the breast 

Accidents of pregnancy 

Puerperal haemorrhage 

Other accidents of labor 

Puerperal septichaemia 

Following childbirth (not otherwise defined) 

Furuncle 

Acute abscess 

Other diseases of the skin and annexa 

Diseases of the bones (tuberculosis excepted) 

Diseases of the joints (tuberculosis and rheumatism 

excepted) 

Congenital malformations (stillbirth not included). 

Poisoning by food. 

Burns (conflagrations excepted) 

Traumatism by cutting or piercing instruments 

Traumatism by fall 

Traumatism by other crushing (vehicles, railways, 

landslides, etc ) -- 

Other external violence. __. 

Ill-defined organic diseases 



Total . 



1 

14 
8 
4 
4 
6 

1 

4 
1 
1 
1 
1 

14 
7 
2 
1 
2 
3 

2 

1 

2 
5 
2 
9 
1 
3 
1 
3 
2 
3 
15 
7 
3 
8 
2 
4 
2 
1 
5 
1 
1 
1 
8 
2 
1 

12 
4 
12 
2 
1 
3 
10 
10 
1 

1 
1 

1 
1 
7 
4 



401 56 



30 
40 
16 



24 
15 



20 
'20" 



13 



15 
"i2' 



32 

67 

23 

5 



20 
99 
30 



11 
7 
4 
4 
5 



1 
1 
12 



1 
2 
1 
3 
12 
7 
3 
7 
2 
3 
2 
1 
3 



7 
2 
1 

11 
4 

11 
1 
1 
1 
8 

10 
1 



6 

4 

13 
5 
2 . 



188 

Summary and Miscellaneous. 

Total number of patients admitted during the year 309 

Clinics : 

Medical 179 

Surgical 67 

Eye, ear, nose and throat 3 

Obstetrical 18 

Pediatrics 42 

Nationality of patients ; 
Filipinos — 

Christians 286 

Non-Christians 10 

Chinese 6 

Japanese 6 

Other nationalities 1 

Sex of patients: 

Males 216 

Females 93 

Class of service: 

Charity 78 

Government pay 142 

Private pay 89 

Operations performed: 
Minor — 

Filipinos — 

Christians 47 

Non-Christians 1 

Major — 

Filipinos 8 

Operations performed: 
Minor — 

Charity 9 

Government pay 7 

Private pay 5 

Major — 

Charity 1 

Government pay 2 

Prescriptions filled: ^ 

Charity 127 

Government pay 303 

Private 165 

Number of outside calls made by hospital medical staff 17 

Number of visits by out-patients 501 

Average visits of out-patients 4.1 

Hospital Accounts, 

Debit. Credit. 

Allowance for patients 1^1,489.85 

Allowance for personnel 1,210.77 

Expenditures for subsistence of patients and personnel ^2,160.31 

Collections 2,130.21 

Total 2,160.31 4,830.83 

Balance 2,670.52 



189 



RIZAL MEMORIAL HOSPITAL. 
Hospital cases. 



Number and diagrnosis. 



90. 

91. 

96. 

99. 
103. 
104. 
105. 
106. 
107. 
108. 
110. 
115. 
120. 
123. 
124. 
130. 
133. 

134. 
136. 
137. 
143. 
144. 
145. 
149. 
151. 
152. 
171. 
172. 
185. 
186. 



Typhoid fever 

Malaria 

Measles 

Influenza 

Dysentery --- -. 

Purulent infection and septichsemia 

Anthrax _.._ --. 

Beriberi 

Tuberculosis of the lungs 

Acute miliary tuberculosis _ 

Tuberculosis of other organs 

Cancer and other malignant tumors of the stomach, 
liver. 



bo o. 



Cancer and other malignant tumors of the female 

genital organs _ 

Other tumors (tumor of the female genital organs 

excepted) 

Acute articular rheumatism 

Other forms of mental alienation 

Neuralgia and neurit's 

Organic diseases of the heart 

Angina pectoris 

Haemorrhage, and other diseases of the circulatory 

system 

Acute bronchitis 

Chronic bronchitis 

Broncho-pneumonia 

Asthma 

Diseases of the mouth and annexa 

Other diseases of the stomach (cancer excepted) __. 

Diarrhoea and enteritis (under 2 years) . 

Diarrhoea and enteritis (2 years and over) 

Ankylostomiasis 

Intestinal parasites 

Apendicitis and typhlitis 

Other diseases of the intestines 

Other diseases of the liver 

Bright's disease 

Calculi of the urinary passages 

Diseases of the bladder 

Other diseases of the uterus 

Nonpuerperal diseases of the breast (cancer ex- 
cepted) 

Accidents of pregnancy 

Other accidents of labor 

Puerperal septichaemia 

Furuncle 

Acute abscess 

Other diseases of the skin and annexa 

Other diseases of the organs of locomotion 

Congenital debility, icterus and sclerema 

Other diseases peculiar to early infancy 

Traumatism by cutting or piercing instruments 

Traumatism by fall 

Fractures (cause not specified) 

Other external violence 

Cause of death not specified or ill defined 



Total 306 






4 
12 

2 
36 

6 

1 



6 
1 
8 
1 
1 
1 
1 
1 
1 
6 

1 

48 

59 

1 

1 

1 

3 

1 

25 



57 



190 

Summary and Miscellaneous. 

Total number of patients admitted during the year 30t^ 

Clinics : 

Medical 108 

Surgical 27 

Obstetrical 65 

Eye, ear, nose, and throat 1 

Pediatrics 41 

Feeding cases 64 

Nationality of patients : 

Filipinos (Christians) 305 

Chinese 1 

Sex of patients : 

Males 125 

Females 181 

Class of service: 

Charity 121 

Government pay. 34 

Private pay 151 

Operations performed: 
Minor — 

Filipinos (Christians) 6 

Major — 

Filipinos (Christians) 3 

Operations performed: 
Minor — 

Charity 4 

Private pay 2 

Major — 

Private pay.... '. 2 

Government pay 1 

Prescriptions filled: 

Charity 203 

Government pay 95 

Private pay 390 

Number of outside calls made by the hospital medical staff.... 96 

Number of visits by out-patients 1,595 

Average visits of out-patients per day 4.36 

Statements of Hospital Accounts. 

Debit. Credit. 

Allowance for patients M,226.89 

Allowance for personnel 824.07 

Expenditures for subsistence of patients and personnel ^1,410.03 

Collections 2,077.32 



Total 1,410.03 4,128.28 



Balance 2,718.25 



191 
VII. 

LABORATORIES. 

There were, during the year, 10 laboratories in operation, one 
in each of the Provinces of Agusan, Davao, Lanao, Misamis, Sulu 
and Surigao, and two each in the Provinces of Cotabato and Zam- 
boanga. Besides the bacteriological routine work in the hos- 
pitals, the laboratories rendered invaluable help in making a 
study of the prevalence of intestinal parasites and in the prompt 
and early detection of communicable diseases. The Zamboanga 
laboratory, located at Zamboanga, serves as the central laboratory 
where examinations have been and are being made for the other 
provinces of the division. 

Below are shown the number of examinations performed dur- 
ing the year : 

Agusan laboratory: 

Blood 246 

Urine 177 

Stools 142 

Sputum 20 

Discharges 12 

Total 597 

Cotabato laboratory: 

Blood 131 

Urine 125 

Stools 200 

Sputum 9 

Discharges 113 

Total 578 

Davao laboratory: 

Blood 39 

Urine 39 

Stools 95 

Sputum 13 

Discharges 1,766 

Total 1,952 

Lanao laboratory: 

Blood 20 

Urine 482 

Stools 511 

Sputum 8 

Discharges 35 

Total - 1,056 



192 

Misamis laboratory: 

Blood 835 

Urine 178 

Stools 1,837 

Sputum 12 

Total 2,862 

Sulu laboratory: 

Blood 101 

Urine 441 

Stools 397 

Sputum 34 

Discharges 76 

Total 1,049 

Zamboanga laboratory: 

Blood 74 

Urine 354 

Stools 1,148 

Sputum 61 

Discharges 540 

Water 78 

Miscellaneous 12 

Total 2,267 

VIII. 

SAN RAMON PENAL FARM. 

Till the arrival of a colony physician, the medical attendance 
of the about 600 inmates of San Ramon Penal Farm has been 
done by the municipal health officer of Zamboanga, stationed at 
Zamboanga. There was one dispensary at the San Ramon 
Penal Farm in charge of one attendant. 

On July 7, 1918, the colony physician arrived. Of course, 
medical attendance and sanitation were improved. The pris- 
oner's diet was also improved. Several operations were per- 
formed. 

Hospital summary: 

Number of cases admitted —. 1,052 

Number of operations performed 36 

Number of dressings 1,071 

Number of deaths '. 38 

Number remaining 21 

Dispensary summary: 

Number of cases admitted (July to December) 1,555 

Number of treatments (July to December) 31,117 



193 

Dangerous communicable diseases registered among the 

inmates: Cases. Deaths. 

Cholera 1 1 

Varicella 23 

Pulmonary tuberculosis ..-. 23 8 

Dysentery 15 1 

Mumps 127 

Dengue fever 1 

Typhoid fever 1 1 

Grippe 220 

It is recommended that the hospitals facilities and supplies 
be increased in order that the health of the inmates may be prop- 
erly cared for. 

IX. 

WATER SUPPLIES. 

There are six sources of water supply in this division for either 
drinking or domestic purposes, namely: (1) artesian wells, (2) 
rain water, (3) springs, (4) rivers, (5) surface wells and (6) 
distilled water. 

Due perhaps to physical pecularities of certain provinces of 
this division and to the lack of funds in general, the perforation 
of artesian wells could not be extended throughout all the prov- 
inces. During the year only the Provinces of Agusan, Lanao, 
Misamis, and Zamboanga had artesian wells. They are located 
as follows: Agusan Province — Butuan 7, Cabadbaran 12, and 
the municipal district 3; Lanao Province — Iligan 2; Misamis 
Province — Cagayan 1; and Zamboanga Province — Dapitan 7, 
and Lubungan 1. In Surigao, perforation of a well was tried 
four times but iall in vain. In Cotabato an attempt also failed. 

Rain water is used in all the provinces, but only by very few 
and mostly well-to-do people. Only Agusan has tanks, one of 
which has a capacity of 3,000 gallons, wherein rain water is 
stored for public consumption. 

Distilled water is only purchasable in the provincial capitals 
of Cotabato, Sulu and Zamboanga, but only very few, mostly 
the well-to-do class, use it for drinking purposes on account of 
its extra cost. 

Springs abound in many places, especially in Sulu. In the 
municipal district of Jabonga, Province of Agusan, the water 
of a spring, which is considered potable, is piped to the town. 
In Parang, Cotabato, there is one spring from which the inhabi- 
tants get their drinking water. The municipalities of the Island 
of Camiguin, Misamis, are provided with water piped from a 

168426 13 



194 

spring. The water system in the municipalities of Balingasag 
and Cagayan are yet under construction. Jolo and Siasi, Prov- 
ince of Sulu, are well supplied with potable water from good 
springs brought to the people by gravity. The municipality of 
Maluco and the barrio of Dal^rig, Province of Bukidnon, are also 
provided with water by gra/ity; in Malaybalay, the capital, a 
system is under construction and will be inaugurated in the near 
future. The necessary appropriations have already been pro- 
vided for the construction of water systems in the municipalities 
of Placer, Bacuag and Lianga, Province of Surigao. The sys- 
tems are now under construction. The waterworks plan for Su- 
rigao, the capital, is now under construction. The municipality 
of Zamboanga and adjoining barrios are supplied with potable 
water piped from the Pasonanca reservoir. The following is a 
report of the water examinations from March to December 1918, 
inclusive, of the Pasonanca water. There were 28 examinations. 



[From Zamboanga Laboratory.] 










Number 

of 
samples. 


Positives. 
3 


Nega- 
tives. 


Presumptive test . __ . 


28 
28 
28 
28 
28 


25 


Bacillus coli . .- -. . _. - _. 


28 


Amcebae . 


1 

13 

25 

From 30 

to 1, 500 


27 


Ciliates 


15 


Flagelletes . . .. . .. . _ . 


3 


Number of colonies per cc 




Cholera vibrio _. 


28 


2^ 









Where the sources above-mentioned are not available, the in- 
habitants, mostly of the barrios and remote districts, depend on 
well and river water which is easily contaminated. 

As a matter of curiousity this office has requested the district 
health officers to include in the annual report an answer to the 
following question : ''What is the one thing you will recommend 
that in your opinion will render the best service in the interest 
of public health in your district for the year 1919 V Of the eight 
answers received, Lanao, Cotabato, Zamboanga, Sulu, Davao, 
and Surigao recomemnded good water supply. 

X. 

DISPOSAL OF EXCRETA. 

There are at present three approved ways of disposal of excreta 
in practice in the division, namely: (1) The septic tank, (2) the 
"Antipolo'' and (3) the pail systems. Emphasis has been and is 
being laid on the safe disposal of human waste as one of the 



195 

principal sanitary measures, but due to the peculiar condition 
existing in the various municipalities and municipal districts the 
practice cannot at once be put into general use. This is especially 
true among the non-Christians whose religious belief on the 
matter is in controversy with modern systems. Their religion 
dictates that human waters must be made to fall first on a work 
of nature ; hence their custom of defecating in rivers and streams 
from which they take their water for drinking and domestic 
purposes. However, in the organized municipalities the "Anti- 
polo'^ system is now being adopted and at the close of the year, 
besides those under construction, the following table shows the 
number of ''Antipolo" toilets in each province: 

No. of "Antipolo" toilets. 

Agusan 828 

Bukidnon 1 

Cotabato 165 

Davao 40 

Misamis 5,436 

Surigao 7,364 

Zamboanga 1,207 

Total 15,041 

XL 

vitatj statistics. 

Due to the failure of the majority of the municipality officials 
to appreciate the value of vital statistics, our efforts in securing 
them have not as yet given the desired results. This is especially 
true among the Mohammedans who constitute the larger portion 
of the population. The data from the Christians are more 
reliable. 

Below is shown the data reported : 

Marriages for the calendar year 1918. 





Total 


Nationality. 




Single males married 
to females. 


Provinces. 


marri- 
ages. 

170 

56 

64 

287 

89 

1,504 

5 

995 

655 


Filipinos. 

170 

56 

64 

286 

89 

1,501 

5 

995 

638 


Other 
Euro- 
peans. 


Chinese. 


Other 
Asiatics. 


Single. 


Wid- 
owed. 

23 

I 

12 
3 
25 


Divorced, 


A usan 








139 
27 
54 
232 
86 
1,304 
5 
387 
598 


1 












Cotabato 








3 






1 
















1 


2 






Sulu 














272 
19 




Zamboanga 




14 


3 


1 






Total 


3,825 


8,804 


1 


17 


3 


2,832 


367 


5 



196 

Marriages for the calendar year 1918 — Continued. 





Provinces, 


Widow 

Single. 

1 
11 


ed males married 
to females. 

WKi- Divorced. 


Agusan. 


6 


But«idnon.-- . 


11 '■ 


Cotabato . . ._ ... .. 


1 


Davao - 


18 


25 


Lanao - .. - .. .. 




MisamiBa- .. 


. 

103 


71 i 


Sulu 




Surigao- ._ .. 


198 
27 


138 


Zamboarga..- 


9 1 








Total . 


358 


261 2 






1 



Nationality of females. 



Other 



170 

56 

64 

286 

89 

1,502 

5 

995 

638 

3,805 



' Up to September 80th only. 

Marriages by age. 

AGUSAN. 





Males. 


Num- 
ber. 






Females. 






Ages. 


Under 

15 
years. 


15 to 20 20 to 25 
; years, years. 

■ 82'^"-^.';"; 

, 6 ; 42 

1 M I 


25 to 30. 
years, i 

; 

16 1 

1 1 


: j 

iQ to 40 40 to 50 Over 50 
years. , years. 1 years. 

i 


Under 15 years 

15 to 20 years . 


82' 
48 
18 
14 
3 
5 

170 


! 


20 to 25 years 


j ■ 


25 to 30 years 








30 to 40 years - 




12 


40 to 50 years 




2 1 


Over 50 years. 








5 


Total 


-- 


1 89 j 44 


~~~i7i 


14 ! 6 j 









BUKIDNON. 



Under 15 years 


2 
18 
18 
15 

3 


2 
8 
8 
2 










15 to 20 vears 


' 7 i" 


2 




20 to 25 years 


8 
8 
1 


2 

t 


1 i 




25 to 30 years 


i 1 .J 




30 to 40 years ._ . 






40 to 50 years 


1 i 




Over 50 years . 




! 














24 9 


i 




Total - - 


56 


20 


3' 1 






1 





COTABATO. 



Under 15 years 
15 to 20 years .. 
20 to 25 years.. 
25 to 30 years. - 
3Q to40years-- 
40 to 50 years .. 
Over 50 years -- 

Total 



197 

Marriages by age — Continued. 

DAVAO. 



Males. 



Ages. 



Under 15 years . 
15 to 20 ye«»rs--- 
20 to 25 years -.. 
25 to 30 years. - - 
30 to 40 years .-. 
40 to 50 years ._. 
Over 50 years .. 

Total 



Num- 
ber. 



9 
74 
117 
42 
36 

9 



i Tinder 
! years. 



Females. 



15 to 20 20 to 25 25 to 30 30 to 40 
years, years, years, j years 



287 



42 



3 '. 

6 ! 

4 I 
4 



17 I 



40 to 50 Over 50 
years, i years. 



Under 15 years . 
15 to 20 years .. 
20 to 25 years ._. 
25 to 30 years .-. 
30 to 40 years -._ 

40 to 50 years 

Over 50 years... 



Total . 



LANAO. 



23 i 



MISAMIS. 



Under 15 years | 

15 to 20 years I 

20 to 25 years I 

25 to 30 years 

30 to 40 years 

40 to 50 years 

Over 50 years i 

Total I 



116 


107 

105 

43 

13 

8 

1 


i 

8 !. 

389 i 

280 i 

79 i 

21 ! 

^1 


50 

154 

69 

19 

7 

1 


1 
4 
15 
51 
16 
13 
1 








549 




1 


. 




492 






215 


3 
17 

7 
5 






81 






37 
14 


2 
1 


. 










1,504 


277 


784 1 


300 


101 


33 


3 


6 



Under 15 years - 
15 to 20 years _.. 
20 to 25 years... 
25 to 30 years . _ . 
30 to 40 years ... 
40 to 50 years - _ . 
Over 50 years... 



Total . 



SULU. 



SURIGAO. 



Under 15 years 
15 to 20 years .. 
20 to 25 years ... 
25 to 30 years.. 
30 to 40 years .. 
40 to 50 years .. 
Over 50 years.. 

Total ---- 



28 


10 
.. 

_. 

1 


8 
82 
123 
45 
24 
11 


5 
92 
109 
42 
22 

9 


4 

80 
27 
19 
8 
2 

210 


1 

57 

52 

20 

9 

5 

1 

145 






316 

289 

141 

80 

37 

4 

995 


15 
20 
7 
4 
3 
1 

50 




18 


293 


279 





198 

Marriages by age — Continued. 

ZAMBOANGA. 



Males. 
Ages. 

Under 15 years ,. 

15 to 20 years 

20 to 25 years 

25 to 30 years 

30 to 40 years 

40 to 50 years 

Over 50 years 

Total 



Total . 





Under 

15 
years. 

8 
13 
6 
3 


15 to 20 
years. 

1 
131 
169 
61 
15 
5 


F'emales. 






Num- 
ber. 

9 
170 
256 
134 


20 to 25 
years. 


25 to 80 ! 30 to 40 
years, i years. 

. j . - . - 


40 to 50 
years. 


Over 50 
years. 






20 
72 
47 
17 
4 
1 

161 


5 1 1 

6 1 2 
17 ' 6 
15 i 13 

2 1 4 
3 

45 29 






1 




60 






17 
9 

655 


2 

4 

7 


_ 


30 


382 


1 



SUMMARY BY AGES. 



Under 15 years 
15 to 20 years.- 
20 to 25 years.- 
25 to 30 years. - 
30 to 40 years.- 
40 to 50 years . _ 
Over 50 years -_ 

Total 



Agusan 

Bukidnon 

Cotabato 

Davao 

Lanao 

Misamisa 

Sulu 

Surigao 

Zamboanga . 



District. 



1 
176 ; 


141 


21 


8 


5 


1 


1,249 ' 


162 


764 


168 


81 


59 


1,394 , 


88 


691 


431 


109 ! 


54 


586 ^ 


20 


225 


180 


124 1 


30 


282 ; 


10 


79 


76 


59 I 


52 


105 ; 


2 


23 


22 


27 ! 


22 


33 i. 
3. 825 ; 






2 

887 


3 

408 


10 


423 


1,803 




228 







15 




21 




7 




5 


1 


9 




11 


7 


68 


« 



Births reported. 



Amer- 



iFilipinos. 



605 

567 

312 

932 

181 

6,180 

204 

2,163 

1,001 



12, 145 



Other 

Asiatics. 


Ch 


nese. 


Other 
national- 
ities. 


Total. 

605 










567 






1 




313 




932 










181 


3' 




1 

29 





6,181 

237 

2,163 


1 





4 


1 


1,008 


4 


35 


1 


12, 187 



" Up to September 30th only. 
SUMMARY. 



Agusan.. , 

Bukidnon 1 

Cotabato i 

Davao 1 

Lanao - -I 

Misamis ! 

Sulu - I 

Surigao 1 

Zamboanga i 

Total ' 12,187 





Annual 


dumber 


birth rate 


of 


per 1,000 


births. 


popula- 




tion. 


605 


26.92 


567 


27.08 


313 


31.71 


932 


22.10 


181 


11.97 


6,181 


46.61 


237 


10.24 


2, 163 


23.17 


1,008 


12.37 



27.62 



199 

Deaths reported. 



Amer- 
icans. 



Ag-usan 

Bukidnon _.. 

Cotabato 

Davaoa 

Lanao 

Mieamis b _._ 

Sulu 

Surig-ao 

Zamboan>jra . 

Total.. 



Filipi- 
nos. 



854 
346 
270 

1,230 
3S1 

5,825 
204 

2,390 

2.243 

13, 743 



Euro- 
peans. 



Chinese. 



Other 
Asiatics. 



Other ' 
national- | 
ities. 



6 
17 i 



'83 1 



I 



61 



Total. 



854 
346 
277 

1.399 
382 

5,829 
237 

2,402 

2,262 



13, 988 



« In addition to the total of 1,S99 deaths, there are 148 deaths whose nationalities were 
not reported, thus making a total of 1,547 deaths, 
b Up to September 30th only. 

SUMMARY BY PROVINCES. 



Agusan 

Bukidnon .. 

Cotabato 

Davao 

Lanao 

Misamis 

Sulu 

Surigao 

Zamboanga 

Total . 





Annual 


Number 


death- 


of 


rate per 


deaths. 


100 popu- 




lation. 


854 


38.00 


346 


16.52 


277 


28.06 


1,547 


36.68 


382 


25.28 


5,829 


43.95 


237 


10. 24 


2,402 


25.73 


2,262 


27.76 


14, 136 


32.04 



It will be noted that, in spite of the epidemics of smallpox, cholera and influenza, the 
number of deaths compared with that of births is only 1,949 in excess of the latter, but 
taking into consideration the fact already stated in previous reports that no non-Christian 
births have ever been reported while deaths among them, especially during epidemics, are 
registered as far as possible, it can be seen that the loss to the community is practically nil. 

Deaths reported by ages. 





. 

< 

62 
156 
50 
68 
67 
84 
54 
74 
66 
67 
37 
23 
23 
13 
6 
4 


Bukidnon. 


Under 30 days - . 


1 

16 
32 

37 


•"■Odays to under 1 year 

1 year to under 2 years 

2 years to 4 yeai'S 

f) years to 9 years 


10 years to 14 years 

15 years to 19 years 


23 
26 


20 years to 29 years 

30 years to 39 years 


33 
49 


to years to 49 years.. 


35 


50 years to 59 years. _. 


^^ 


60 years to 69 years 

70 years to 79 years 


25 
14 


80 years to 89 years . 


8 


90 years to 99 years 


4 

1 


100 ypars and over 


Age not stated _ 








Total 


854 


346 



25 

51 

38 

42 

24 I 

11 

17 

23 

15 

16 

3 

7 

2 



49 

149 

139 

128 

98 

67 

123 

210 

169 

124 

55 

48 

25 

9 



277 1 1,399 



47 
52 
46 
40 
53 
44 
33 I 
23 I 
17 ! 
10 i 
5 I 



li 



512 

1,497 

521 

645 

438 

221 

196 

456 

367 

263 

228 

210 

97 

92 

31 

48 

7 



382 5,829 







a 








bo 








c 






rt 


s 








Xi 




3 


•E 


a 


5 


P 


3 


d 


o 


W 


m 


N 


H 


59 


137 


154 


821 


26 


276 


446 


2,075 


10 


251 


131 


1,056 


16 


242 


206 


1,224 


11 


277 


196 


1,056 


10 


149 


88 


645 


7 


164 


106 « 


693 


30 


177 


231 


1,110 


17 


172 


224 


1,004 


17 


134 


149 


741 


17 


148 


106 


574 


7 


108 


86 


452 


6 


79 


55 


268 


4 


56 


38 


197 




25 


24 


83 




3 


6 


54 




4 


16 


29 


237 


2,402 


2.262 


12,092 



« In addition to the total of 1,39! 
thus making a total of 1,547 deaths. 
»» Up to September 30th only. 



deaths there are 148 deaths whose ages were not reported. 



200 

Cases of deaths reported. 



Number and diagnosis. 


c 



be 
< 




1 


d 


4 


1 «• 

1 s 

! - 

1 s 


C/3 


i 

3 
CO 


CO 

e 


e2 


1. Typhoid fever 


2 


4 
12 
43 

88 


3 

...... 

1 

78 
3 


34 

5 

129 

156 

1 
250 


''7 :::::: 


13 

4 

117 

186 

68 

7 


24 
2 
3 
152 
8 

28 


20 


2. Typhus fever 


3 


3, Relapsing fever 




2« 


4. Malaria .. 


187 
3 


24 
"l64" 


944 
2 
12 

18 


53 


1,79 


4a. Malarial cachexia 


8 


5. Smallpox 


54 


6. Measles 






2 


7. Scarlet fever 














1 
4 

"me 




8. Whooping cough 


32 




22 


2 




374 
3 

4 
86 
2 

754 


...... 


i2 

1 

2 

297 


44 


9. Diphtheria and croup 




9a. Croup 




2 
121 




1 




10. Influenza .. .. 


276 
1 
73 
1 
9 
1 


56 


49 


16 


1.51 


11. Miliary fever 

12. Asiatic cholera 










39 




431 


100 

19 
38 


1,34 


13. Cholera nostras 








2 


14. Dysentery 


36 


1 
1 
2 


116 


10 


i33 

44 
82 

7 

27 

1 

11 

4fi2 

378 

1 


5 
1 


180 


52 


18. Erysipelas 


4 












8 


20. Purulent infection and septi- 
chaemia 








19 
4 


2 


22. Anthrax 


1 


1 




1 






1 


3 


23. Rabies 




24. Tetanus 


5 
18 
31 


i 

9 

7 


4 
6 
14 


6 

108 

33 

3 


1 

3 

10 

...... 


1 
9 
12 


"""39' 
96 
23 


2 
223 
129 
1 
2 
3 


3 


27. Beriberi 


87' 


28. Tuberculosis of the lungs 

29. Acute miliary tuberculosis 


71( 
2J 


31. Abdominal tuberculosis 








12 

7 




t 


32. Pott's disease 




1 










33. White swelling 
















li 


34. Tuberculosis of other organs 






2 
2 


3 
..... 









8 
5 
3 


2( 


36. Rickets 






2 


i 


37, Syphilis 






i 


( 


38. Gonococcus infection 










1 

' 5 





] 


39. Cancer and other malignant 
tumors of the buccal cavity 














1 
2 


2 
3 


i 


40. Cancer and other malignant 
tumors of the stomach, liver 






1 
1 


i 


2 




11 


41. Cancer and other malignant 
tumors of the peritonaeum 






1 




42. Cancer and other malignant 
tumors of the female genital 






1 

J 


2 

2 








2 


43. Cancer and other malignant 
tumors of the breast 


1 






i . 




2 
1 


1 
1 

3 


d 


44. Cancer and other malignant 
tumors of the skin 








19 ■ 


21 


45. Cancer and other malignant 
tumors of other organs and of 
organs not specified 










6 

6 
14 




S 


46. Other tumors (tumors of the 
female genital organs ex- 
















e 


47. Acute articular rheumatism 








5 
1 


..-._. 




5 
6 
1 


3 
3 


27 


48. Chronic rheumatism and gout __. 

49. Scurvy 


2 




1 


10 ! 

11 ' 


24 
12 


50. Diabetes 






i 


1 

1 




4 


51. Exophthalmic goitre - 




j 1 




1 


1 


52 Addison's disease 












1 
...... 


J 


54. Anaemia chlorosis 




2 


1 


1 
13 


1 


3 ; 


9 

222 

2 


6 
2 


23 


55. Other general d'seases 




24U 


56. Alcoholism (acute or chronic) 








1 


a 


58. Other chronic occupational poi- 
sonings 




1 
1 


1 
2 






1 


59 Other chronic poisonings 




1 










2 


60. Encephalitis 






1 
1 




2 

4 








3 


61. Simple meningitis 




1 


23 

2 
4 




1 
2 


7 

1 

4 


15 

1 

8 
3 

7 
2 

1 


51 


61.a Meningitis, cerebro spinal, epi- 




4 


64. Cerebral haemorrhage, apoplexy _ 

65. Softening of the brain . 


2 


--1 ^ 




1 ! 


25 
4 


66. Paralysis withouts pecified cause 


1 


1 " 1 




18 ! 1 


31 


67. General paralysis of the insane 


1 




1 j 




3 


68. Other forms of mental alienation. 




! 2 






i 


4 



» In addition to the total of 1,399 deaths there are 148 deaths whose causes of death, 
nationalities, ages and civil status were not reported, thus making a total of 1,547 deaths. 
* Up to September 30th only. 



201 

Cases of deaths reported — Continued. 



69. 
70. 
71. 
72. 
73. 
74. 



77. 
78. 
79. 
80. 
81. 

82. 



84. 

85. 

86. 
87. 
88. 
89. 
90. 
91. 
92. 
93. 
94. 

9r.. 

97. 
98. 



100. 
101. 
102. 
103. 

104. 



106. 
107. 
108. 
109. 
110. 
111. 

113. 
114. 
115. 
116. 
117. 

118. 



119. 
120. 
121. 
122. 

123. 
124 
126. 
127. 

128. 

129. 
130. 



Number and diagnosis. 
Epilepsy . 


c 

C3 

be 

< 


. 

c 
o 
c 

PQ 
1 


s 

o 


6 

> 
Q 


c 

1 

1 


• 

52 
12 
544 
6 
10 

2 

3 


3 

1 


1 

3 


c 

1 

E 
t3 


5 

64 


Convuls ons (nonpuerperal) 






5 
71 


1 

33 
1 

2 


5 

58 


"m 


24 


Convulsions of infants 

Chorea . . .. 


89 


13 


3 


999 

7 


Neur< l^ia and neuritis 


1 






1 


1 


6 


4 

3 
1 

11 
10 

2 

1 

2 

1 

...... 

42 

23 

46 

6 


17 


Other diseases of the nervous 
system .. - 






10 


Diseases of the eyes and their 
annexa . - . _. 












6 


Pericarditis 

















1 


Acute endocarditis- -_ 






1 
2 


4 
1 
1 








16 


Organic diseases of the heart 

Agina pectoris. .. . 


1 






9 
1 


3 


2 
1 


28 
3 


Diseases of the arteries, athe- 
roma, aneurysm, etc - - 








2 


Embolism and thrombosis _ 






1 








2 
1 

1 
2 


3 


Diseases of the veins (varices, 
hemorrhoids, phlebitis, etc . _. 














1 


Diseases of the lymphatic sys- 
tem (lymphangitis, etc.) - - 
















1 


Hemorrhage, and other diseases 
of the circulatory system . 






1 


1 


3 

2 

1 

1 

107 

124 

163 

30 

12 




9 


Diseases of the nasal fossae 










8 


Diseases of the larynx - 










"'i2' 
5 


1 

' '65' 
15 
4 
1 


2 


Diseases of the thyroid body 




1 
2 
2 
5 
5 


16 
20 
63 
9 
2 

1 
8 
5 

13 


12 
2 
8 
6 


4 


Acute bronchi Ms . . 


! 


256 


Chronic bronchitis 


13 i 

49 1 

15 : 


199 


Broncho-pneumonia 


346 


Pneumonia - 


77 


Pleurisy 


2 




16 


Pulmonary congestion, pul- 
monary apoplexy 

Asthnrta 








i 




21 
10 

26 


3 

6 

1 

1 

2 
2 


25 


2 j 2 


1 


13 


3 


46 


Pulmonary emphysema . .- ._ 


8 


Other diseases of the respira- i j 
tory system (tuberculosis 1 j 
excepted) . ._ . _ .' 1 






2 

2 
2 
1 

8 

18 
69 
36 


1 


43 


Diseases of the mouth and an- | | 
nexa . .. ' 




4 


Diseases of the pharynx .^ . '* i 












4 


Diseases of the oesophagus i 


2 

5 

14 
19 
11 




9 
3 


3 


Ulcer of the stomach .. . ' '• I 


1 
4 


4 

8 

16 

17 
1 
4 


6 

3 

14 

24 
4 
8 
2 
9 
8 


23 


Other diseases of the stomach 1 j 
(cancer excepted) ; 1 ! 

Diarrhoea and enteritis (under 2 ! ! 
years) . . _. i ! 


1 

4 

2 

2 


46 
135 


Diarrhoea and enteritis (2 years 
and over) .. .__.. .. 


e; 2 


101 


Ankylostomiasis.. 




3 


10 


Intestinal parasites \ 4 

Appendicitis and typhlitis _ 




2 
1 
2 

1 


3 


21 




3 


3 




6 


Hernia, intestinal obstructions. _ 

Other diseases of the intestines . 

Acute yellow^ atrophy of the 

liver 


' 





1 6 

1 5 




2 
3 

3 




20 
20 






3 


Cirrhosis of the liver .. j 











1 


■T 


2 


Biliary calculi ._ • 










1 


Other diseases of the liver ! 




2 

1 

3 

3 
3 


! 




3 

1 

1 

1 
5 
7 
3 


5 


Diseases of the spleen ... 






2 

2 

2 6 
5 i 18 


2 

3 
1 


1 

7 
10 


6 


Simple peritonitis (nonpuer- 1 
peral) ; 






8 


Other diseases of the digestive ' 
system (cancer and tubercu- ; 
losis excepted) < 1 

Acute nephritis 




1 


21 

45 


Bright's diseases i 




1 




3 


14 


Chyluria 






1 




5 


Other diseases of the kidneys 
and anneva 










1 

1 
2 


1 


Calculi of the urinary 








1 


1 




5 
3 






Diseases of the bladder ___ 






1 




6 


Diseases of the prostate 






1 


Nonvenereal diseases of the 
male genital orgins 










1 

1 
4 








1 


Uteine hemorrhage (nonpuer- 
peral) 






1 
1 


1 






1 
1 
3 


.-...- 


4 


Uterine tumor (noncancerouB).. 






6 


Other diseases of the uterus 













4 



202 

Cases of deaths reported — Continued. 



132. 

134. 
135. 
136. 
137. 
138. 

139. 

140. 

142. 
143. 
144. 
145. 

146. 

147. 

149. 

150. 

151. 

152. 

153. 

154. ; 

155. : 

156. ; 
157. 

159. i 

160. i 

161. 

162. 

164. 

165a. 

165b. 

166. 

l67. 

;69. 

{70. 

^71. 

1 

172. 

173. 

174. 
175. 
177. 
178. 
179. 
180. 
183. 

184. 
185. 
186. 
187. 
188. 
189. 



Number and diaprnosis. 


3 

< 


c 
o 

c 


1 


i 
> 

Q 


i 

c 




3 
CO 


1 

CO 


i 

G 

1 

1 

"'ih' 

6 
4 
4 


5 
& 


Cysts and other tumors of the 
ovary 






1 


Salpingritis and other diseases of 
the female genital organs . 












1 

8 
6 
13 


1 


Accidents of pregnancy 

Puerperal hemorrhage 


2 

I 




1 
1 

1 


2 
2 
3 


i ' 7 ' 

1^ : 1 


36 
30 


Other accidents of labor _ 


1 


17 i...... 

19 2 


45 


Puerperal septichaemia .. 


25 


Puerperal albuminaria and con- 
vulsions . 


i 








1 
2 




1 


Puerperal phlegma-ia, alba do- 
lens, embolus, sudden death. _._ 


! 

i 














2 


Following childbirth (not other- 
wise defined) 


! 
! 








2 

7 
54 
27 

53 






3 
3 

1 


5 


Gangrene. -_ .-. ._ 








1 






3 

7 
4 

8 


14 


Furuncle ._ 








61 


Acute abscess . 








6 

1 
1 




41 


Other diseases of the skin and 
annexa . . 








63 


Diseases of the bones (tubercu- 
losis excepted) - 








5 




6 


Diseases of the joints (tubercu- 
losis excepted) 










' 




7 


Other diseases of the organs of 
locomotion .. -- . 












2 
5 




2 


Congenital malfomation (still- 
births not included) -- 












3! 1 


3 

68 

20 
72 
69 


12 


Congenital debility, icterus and 
sclerema 


16 

3 

29 
8 




4 
3 


7 

13 

7 
16 


2 

1 


223 ^ 11 fifi 


397 


Other diseases peculiar to early 

infancy 

Lack oi care 

Senility 

Suicide by poison - . . .. 


87 

10 

111 

1 


1 

4 1 55 

58 

9 39 


186 

182 

254 

1 


Suicide by asphyxia - ' ' 










1 




1 


Suicide by hanging or strangu- j 
lation . . -. .- _-L 










4 




4 


Suicide bv firearms .. 






1 

1 






1 


1 
1 


3 


Suicide by cutting or piercing | 
instruments 











2 


Suicide by jumping from high 1 

place ... - - 1 __ .. 


i 




1 

1 


1 


2 


Suicide by "^.rushing 


\ 






1 


Poisoning by food _. 1 








1 




J 


1 

""l 

1 
3 

4 

'2 
3 


3 


. Venomous bites and stings | 1 








2 
2 
1 
5 
6 




7 


. Other acute poisonings 








-.:::::! ! 


4 


Ci^nflagration ' 




1 
1 






7 


Burns (conflagration excepted) i 1 




4 
1 
1 

7 
4 




12 


Accidental drowning 


i 4 


i| 1 

12 


18 


Traumatism by firearms.- . - .. 






12 


Traumatism by cutting or pier- j 

cing instruments j _, _. 


i 




3 

7 

1 
1 


24 


Traumatism by fall j 






14 


Traumatism in mines and quar- j 
ries - J 








1 


Traumatism by machines 


I-- 
















1 


Injuries by animals ._ ._ 






1 












2 


Starvation ._ _ 


i 








1 






1 


2 


Excessive cold 






3 
3 










3 


Effects of heat 












1 




3 


Lightning . __ _ . . .._. 










2 
3 








2 


Homicide by cutting or piercing 
instruments 








2 




3 


3 
1 
1 


2 
61 


11 


Homicide by other means 










1 


Fractures (cause not specified) '< 






1 








5 


Other external violence . | . 








1 
2 

7 

231 




3 


Ill-defined organic diseases ■ 




1 


2 




1 4 

1 14 

.._...! 23 


9 


Sudden death . . .i-. 





3 i 1 
66 46 


25 


Cause of death not specified or 
ill-defined ... 

Total 


3 


1 

! 2 

1 


432 


854 


346 


277 


1,399 


382 


5,829 


237 


2, 402 


2,262 


13.98 



203 



Deaths reported by civil status. 



Civil status. 



Married 

Widowed - - - 

Di vorced 

Single 

Children 

Condition not stated in certificates. 

Total 



Ai?u- P."r 'Cota- Da- 
«an. r:ll- bato. vao. 



182 
20 
30 

135 

487 



112 i 
71 



64 
99 



867 
83 



52 
15 
3 

34 362 

167 1 452 

6 I 135 



854 I 346 277 ! 1.399 



La- 
nao. 



64 

227 

14 



Misa- e 1 iSuri- 
mis.b ^"*"-j jrao. 



1,132 

389 

3 

471 

2.834 



I 



5,829 



Zam- 
boan- 



650 
185 



58 
21 

4 i 

22 I 264 
132 i 1.303 

I 



237 12,402 



Total 



594 
179 



3,213 
974 
40 

243 I 1,659 

1,220 7,921 

36 181 



2,262 13.988 



•'In addition to the total of 1,399 deaths, there are 148 deaths whose nationalities, ages 
and civil status were not reported, thus making a total of 1,547 deaths. 
^ Up to September 30th only. 

XII 

CEMETERIES. 

There were at the beginning of the year 269 cemeteries in 
operation; 20 were opened or reopened and 8 closed during the 
year. The following table shows the number of cemeteries in 
each province at the close of the year. 



Agusan 

Bukidnon .... 
Cotabato ..- 

Davao 

Lanao 

Misamis 

Sulu 

Surigao 

Zamboanga 

Total 



Number of 
cemeteries. 

24 
13 

7 
51 

5 
96 

7 
63 
15 



281 



Only in very few organized municipalities cemeteries are kept 
in a satisfactory sanitary condition. Other cemeteries, the ma- 
jority of which are used by Mohammedans only, are not main- 
tained according to the requirements. 

XIII. 

INFANT WELFARE. 

The work of district nurses and midwives consists mainly of 
house-to-house inspection, advice to mothers and parturient 
women on the care of infants before and after delivery. Pri- 
vate and public lectures were given on the subject as often as 
possible. As far as practicable hospitals and dispensaries give 
free service to sick children. It is gratifying to be able to assert 
that mothers are now becoming accustomed to call on the district 
nurses and midwives for advice and help and not very few of 
them (mothers) now prefer to deliver in the hospitals rather 
than in their homes. 



204 

During the year there were in all 14 women's clubs, 1 in Cota- 
bato, 1 in Lanao, 5 in Misamis, 1 in Sulu, 3 in Surigao, and 3 in 
Zamboanga. The work of the clubs so far on infant welfare may 
be classified as initial and cannot be pushed forward with ra- 
pidity because of the many handicaps, notably the lack of funds 
and proper personnel. 

Three baby contests were held during the year, 2 in Jolo and 
1 in Cotabato. 

The problem of infant mortality in this division is about the 
same as in other parts of the Islands — ignorance of the mothers 
of pre-and-post partum, care of themselves and of the care of 
infants. The effect of beriberi is also the same. The solution 
would seem to lie in (1) educational campaign work with re- 
ference to the care of infants, and (2) improvement of the diet 
of the mothers, actual and prospective. 

Below is shown a summary of the work done by the district 
nurses and midwives : 

Zamboanga: 

Number of women given instructions during pregnancy 234 

Number of women attended by local '^parteras" and visited by 

midwives 76 

Premiparae 20 

Multiparae 56 

Number of women attended during labor 99 

Premiparae 20 

Multiparae 79 

Average age years.... 27 

Average duration of pregnancy months.. .. 9 

Average duration of labor hours... 5 

Kind of presentation — 

Head 94 

Breach 2 

Foot - 3 

Average length of time before the expulsion of pla- 
centa minutes. . 30 

Fetus — 

Alive (48 males— 48 females) 96 

Premature, male 1 

Abortion 

Stillborn, male 2 

Complications (cases with bleeding) 4 

Complications (cases with infection) 1 

Extraction of placenta.... 6 

Average duration of convalescence days... 8 

Number of deaths among children of cases attended (still- 
births excluded) (4 males — 3 females) 7 

Number of visits during pregnancy 384 

Number of visits after labor 540 



205 

Zamboanga — Continued. 

Number of women attended during labor — Continued. 

Average number of visits to each patient during pregnancy 

and after labor 9 

Average number of visits made per day 2.5 

Number of women at present receiving instructions on 

nursing and on hygiene of pregnancy 17 

Surigao (July to December) : 
Maternity service — 

Number of young girls instructed on hygiene 1,632 

Number of prospective mothers instructed 269 

Number of confinements attended 2 

Number of women delivered 162 

Number of women cared postpartum 76 

Number of women refusing assistance during labor (assisted 

by local midwives) 160 

General data of mothers — 

Average age (extremes) years.... 18-44 

Premiparae 49 

Multiparae 113 

Legal status — 

Married 157 

Unclassified pregnancy outside legal sanction 5 

Character of labor — 

Abortion 1 

Premature 2 

Normal 155 

Abnormal 4 

Average duration of labor (extremes) hours.... 1-8 

Average duration of third stage do 1-2 

Maternal condition — 

Normal delivery 157 

Abnormal complications 5 

Foetal condition — 





Normal. 


Premature. 


Aborted. 


Stillborn. 




M. 


F. 


M. 


F. 


M. 


F. 


M. 


F. 


Alive 


67 


88 














Dead . ... ..- 




1 


1 


4 


2 


Breast fed 


67 


88 




i 








1 









Average weight (extremes) grams.... 1,100-3,250 

Average duration falling off of cord days.... 2-7 

Babies born normal 68 

Children — 

Number under one year old visited 69 

Breast fed 69 

Number of children treated 35 

Number of mothers instructed on maternal hygiene.. 60 

Number of mothers given treatment 40 

Number of mothers instructed in care of babies 202 

Number of visits made antepartum 86 

Number of visits made postpartum 89 

Average visit per patient visits.... 2-8 



206 

Surigao (July to December) — Continued. 
Maternity service — Continued. 

General data of mothers — Continued. 
Sanitary inspection — 

Number of houses visited to give instruction on 

home sanitation 226 

Number of houses maintained sanitary 53 

Number of houses induced to use potable drinking 

water supply 115 

Number of houses advised to install adequate dis- 
posal of human waste 144 

Number of houses using adequate disposal of human 

waste 600 

Septic tanks 2 

Antipolo systems 2 

Pail systems 266 

Number of houses in poblacion of Surigao 600 

Social service — 

Number of women instructed in domestic art 213 

Number of patients visited in reference to follow up 

cases (convalescent) 27 

Number of patients nursed in their home 56 

Approximate number of families in poblacion of 

Surigao only 434 

Approximate number of population in poblacion of 

Surigao only 11,170 

Miscellaneous — 

Classes of patients — 

Government free 20 

Charity 106 

Cotabato (July to December) : 
Maternity service — 

Number of young girls instructed in hygiene 370 

Number of prospective mothers instructed 78 

Number of confinements attended 33 

Number of women delivered 29 

Number of women cared postpartum (delivered by midwife, 

local) - 10 

Number of women refusing assistance during labor 2 

General data of mothers — 

Average age (extremes) years.. .. 18-35 

Primiparae 2 

Multiparae 37 

Legal status — 

Married 39 

Character of labor — 

Abortion 1 

Premature '. 2 

Normal 32 

Abnormal 4 

Average of duration of labor (extremes) hours.... 2-11 

Average duration of the third state do 2-5 



207 



Cotabato (July to December) — Continued. 
Maternal condition — 

Normal delivery 

Abnormal complications 



Malpresentation of fetus 1 

Placentae previae 1 

Retained placenta 2 

Crede 5 

Manual 27 

Puerperal fever 2 

Obstructing tumors 1 

Duration of puerperium.... days.... 

Foetal condition — 



33 
6 

u. 
1 





1 



14 



Alive - 
Dead . 



Normal. 
M. F. 



14 



Premature j Aborted. 
F. 



M. 



F. I M. 



^i: 



-I 



Stilborn. 



Breast fed 36 

Bottle fed 3 

Average weight (extremes) Not stated. 

Average duration falling off of the cord days.... 3-6 

Average duration of cicatrization of umbilicus do 3-18 

Babies born ill 4 

Children — 

C. D. 

Number of children under 1 year old visited 142 

Breast fed 135 

Bottle fed 7 

Number of children treated 137 

Number of mothers instructed in maternal hygiene 173 

Number of mothers given treatment 133 

Number of mothers instructed on care of babies 198 

Number of visits made antepartum 38 

Number of visits made postpartum 66 

Average of visits per patient days... 2-11 

Sanitary inspection — 

Number of houses visited to give instruction on home sani- 
tation 306 

Number of houses maintained sanitary 165 

Number of homes induced to use potable drinking vv^ater 155 

Number of houses using potable drinking v^ater supplies.... 248 
Number of houses advised to install adequate disposal of 

human waste 176 

Number of houses using adequate disposal of human waste.. 229 

Pit systems 106 

Antipolo systems 26 

Pail systems , 24 

Number of houses in the district (about) 968 



208 

Cotabato (July to December) — Continued. 
Social service — 

Number of women instructed in domestic art 245 

Number of women secured employment 122 

Number of women referred to agency or society for maternal 

relief 122 

Number of patients visited in reference to follow-up cases 

(convalescent) 105 

Number of patients given nursing care at home 95 

Number of families in the district 1,952 

Approximate number of population in the district 4,363 

Miscellaneous — 

Classes of patients: 

Government free 290 

Government pay 1 

Private pay 11 

Charity 293 

Total fees collected pesos.— 6 

Davao (July to December) : 
Maternity service: 

Number of young girls instructed in hygiene 35 

Number of prospective mothers instructed 25 

Number of confinements attended 7 

Number of women delivered 7 

Number of women cared postpartum (delivered by midwife, 

local) 5 

Number of women refusing assistance during labor 

General data of mothers — 

Average ages (extremes) years..,. 29 

Primiparae 3 

Multiparae 4 

Legal status — 

Married 6 

Widowed 1 

Character of labor — 

Abortion 1 

Normal 4 

Abnormal 2 

Average of duration of labor (extremes) hours. .- 12 

Average of duration of the third state do 4 

Maternal condition — 

Normal delivery 5 

Abnormal complication 2 

Hemorrhage 2 

Duration of puerperium days.... 7 

Foetal condition — 





Normal. 


Premature. 


Aborted. 


Stillborn. 




M. 


F. 


M, 


F, 


M. 


F. 


M. 


F. 


Alive 


3 


3 


...... 




Dead 

















Breast fed 
Bottle fed .. 



209 

Davao (July to December) — Continued. 
Maternity service — Continued. 
Foetal condition — Continued. 

Average weight (extremes) grams.... 2,634 

Average duration falling off of the cord days.... 5 

Average of cicatrization of umbilicus do 7 

Babies born ill 

Babies born normal 7 

Children — 

Number of children under 1 year old visited... 35 

c. D. 

Breast fed 31 

Bottle fed 4 

Number of children treated 70 

Number of mothers instructed in maternal hygiene.. 30 

Number of mothers given treatment 6 

Number of mothers instructed in the care of babies.. 35 

Number of visits made on antepartum 61 

Number of visits made on pastpartum 83 

Average visit per patient 10 

Sanitary inspection — 

Number of houses visited to give instruction on 

home sanitation 47 

Number of houses maintained sanitary 29 

Number of houses induced to use potable drinking 

water supplies 23 

Number of houses using potable drinking water 

supplies 28 

Number of houses advised to install adequate dis- 
posal of human waste 19 

Number of houses using adequate disposal of human 

waste 295 

Flush toilets 2 

Septic tanks 4 

Antipolo systems 5 

Pail systems 263 

Number of houses in the district 263 

Social service — 

Number of women instructed in domestic art 31 

Number of patients visited in reference to follow up 

cases (convalescent) 1 

Number of families in the district 276 

Approximate number of population in the district.. 14,00 
Miscellaneous — 

Classes of patients — 

Government free 4 

Private pay 2 

Charity 20 

Total collection of fees pesos.... 45.00 

16842(1 14 



210 
XIV. 

MEDICAL INSPECTION OF SCHOOLS. 

In view of the fact that most of the attention of the health 
personnel was absorbed by epidemics, and the lack of transporta- 
tion, the inspections have not been carried out with more fre- 
quency. 

The most predominant ailments were dental caries, skin di- 
seases and tonsillitis. The percentage of dental caries among 
pupils is amazing and steps should certainly be taken to assign 
dental surgeons in the various towns and municipalities to treat 
them. 

The following is a summary of the inspection done and the 
diseases found during the year : 



Provinces. 



Agusan 

Bukidnon.- 
Cotabato ._ 

Davao 

Lanao 

Misamis 

Sulu 

Surigao 

Zamboanga 

Total 



Number 
of pupils 
inspect- 



104 
2,804 

905 
1,195 

373 
4,149 

418 
1,878 
1,212 i 



Diseases found. 



Scabies. 



24 
106 

1 
38 
277 

58 
74 
96 



Tonsil- 


Conjunc- 


litis. 


tivitis. 







2 


37 


116 


6 


6 


3 


95 


2 


467 


83 


167 


3 


34 


n 1 


8 





Conta- 
Per- I grious 
tussis. I skin 
; diseases. 



11 
22 
63 
131 
4 
60 
67 
15 
3 



1 j 

2 I 



13,038 I 



Conta- 
gious 
eye 
dis 



Dental 
caries. 



1 


13 


17 


199 


4 


136 


60 


145 


11 


604 


4 


221 




165 




132 



1,615 



XV. 

MARKETS AND SLAUGHTERHOUSES. 

All the provinces of this division, except Bukidnon, count with 
at least one concrete market. All of these are located at the 
provincial capitals, except the Lanao market which is at Mala- 
bang. This market at Malabang is of mixed material construc- 
tion, having a concrete floor and light material superstructure. 
Jolo, the capital of Sulu, has two concrete market? At the 
close of the year there were in all 14 concrete markets distributed 
as follows : Agusan 1 ; Cotabato 2 ; Davao 1 ; Lanao 1 , Misamis 
2; Sulu 3; Surigao 4, and Zamboanga 1. The rest ot the mar- 
kets are of provisional construction. They are located over the 
sea where refuse is directly disposed of. This is common among 
the Mohammedans. 

All the municipalities where there are concrete markets have 
sanitary ordinances regarding their maintenance, consequently 
the concrete markets in general are kept in a satisfactory sani- 



211 

tary condition. Venders of ready made food are obliged to 
screen from flies the foodstuff offered for sale. Tiendas are re- 
quired to provide buyers with forks, knives and spoons and suf- 
ficient drinking glasses. In the Province of Sulu most venders 
furnish forks and knives. Drinking water is placed in proper 
receptacles provided with faucets. Special Order No. 12, series 
of 1917, was issued by this office to regulate the sale of tuba. 
Garbage cans are adequately furnished. Caretakers to keep the 
markets clean are always employed. The provisional markets 
cannot be kept in a sanitary condition in view of their defective 
structures. 

There are as yet very few slaughterhouses of permanent con- 
struction in this division. The following towns have slaughter- 
houses: Misamis, 2; Sulu, 1; Surigao, 2; and Zamboanga, 1. 
The one in Sulu needs certain improvements, such as provisions 
for running w^ater and for boiling water. In General, these 
slaughterhouses are maintained in a practically sanitary way. 
Agusan is expecting to have 2 during 1919. Davao has one 
slaughterhouse of temporary construction. 

XVI. 

VACCINATION. 

Two difficulties were encountered in vaccination: (1) Insuffi- 
ciency and unsatisfactory kind of vaccine virus and (2) the 
natural disinclination of people to be vaccinated and even actual 
opposition by the Mohammedans. Among the latter, the health 
service was often placed in a very unfavorable position. After 
preaching the efficacy of vaccination against smallpox they al- 
lowed themselves to be vaccinated. With the virus supplied, the 
vaccination did not prevent or attenuate the smallpox epidemic. 
They even suspected that the vaccination brought on the epidemic. 

Below is shown the consolidated report of vaccinations per- 
pormed during the year : 





Vacci- 
nations 

20,382 
3,442 
33, 467 
24, 514 
31,260 
20, 236 
2.100 
14.462 
26, 796 


Inspec- 
tions 


Positive 

6,441 
2,266 
8. 057 
12, 545 
10. 799 
7,212 
874 
4,693 
8,943 


Neg-ative 


Ag-usan _. . 


14, 374 
3,087 
17, 087 
17, 880 
14.721 
14. 745 
2,080 
10.201 
13. 880 


7,933 


Bukidnon 


821 


Cotabato... _. 


9 030 


Davao 

Lanao. 


5, 335 
3,922 


Misamis .. 


7 533 


Sulu "" " ~ 


1,206 

5, 508 


Suriprao .. .. 


Zamboanga . 


4,937 






Total 


176, 659 


108, 055 


61,830 


46, 225 







212 
XVII. 

EXTRACTS FROM THE REPORT OF THE DISTRICT 
HEALTH OFFICER. 

COMMON DISEASES (RECORDED IN THE DISPENSARIES). 

Cases. 

4. Malaria 94(^ 

10. Influenza 343 

14. Dysentery 125 

19. Other epidemic diseases 75 

75. Diseases of the eyes and their annexa 91 

89. Acute bronchitis 89 

103. Other diseases of the stomach, (cancer excepted) 106 

110. Other diseases of the intestines 135 

145. Other diseases of the skin and annexa 474 

186. Other external violence 523 

Death rate. — The high mortality rate was due to cholera in 
the first 2 months, to influenza in the last 2 months of the year 
and to the high mortality among infants. Forty-one and sixty 
per cent of all deaths among infants below 1 year of age occurred 
in the last quarter of 1918, coincident with the influenza epidemic. 
Peculiarly enough, the records do not show high mortality as- 
cribed to convulsions and beriberi. This is explained by the 
fact that potato and other vitamin-containing foods form a large 
part of the staple food of the Agusan population. 

Municipal sanitation, — Butuan uses both the Antipolo and the 
pail systems of disposal of excreta. There are two cemeteries, 
one market of concrete construction, 7 artesian wells and a tank 
for rain water with capacity of 3,000 gallons. 

Cabadbaran has the Antipolo system, 2 cemeteries, one tem- 
porary building for market, 12 artesian wells. 

Talacogon has the Antipolo system and 2 cemeteries. No ap- 
propriate market and water supply. 

The province is composed of 3 organized municipalities and 5 
municipal districts. The population is composed of Christians 
and non-Christians. These are peaceful, non-abusive nomadic 
people. 

BUKIDNON. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES), 

Cases. 

10. Influenza - 788 

4. Malaria 132 

14. Dysentery 49 

Municipal sanitation. — Malaybalay has the pit system of waste , 
disposal, one municipal cemetery and one provisional market. 
Water is obtained mainly from rainfall and springs. 



213 

Maluco has a gravity system of water supply. 
The population is mainly composed of non-Christians. The 
few Christians present came from Misamis. 

COTABATO. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Cases. 

145. Other diseases of the skin and annexa 5,189 

4. Malaria 2,512 

5. Smallpox 1,840 

19. Other epidemic diseases 1,669 

186. Other external violence 1,146 

103. Other diseases of the stomach (cancer excepted) 1,073 

10. Influenza 1,049 

107. Intestinal parasites 1,003 

75. Diseases of the eyes and their annexa 378 

Next to skin disease, malaria stands as the most common dis- 
ease of the province, where it is constantly endemic and at times 
epidemic. Most of the cases are associated with splenomegalia. 

Municipal sanitation, — Cotabato uses the pail and Antipolo 
systems of waste disposal. There are one Catholic, one Chinese 
and one municipal cemeteries; one market and one slaughter- 
house. Three-fourths of the people use distilled water ; the rest 
use rain water. Rabies is unknown in the municipality for the 
last 5 years. 

One hundred seventy-four sanitary orders were issued during 
the year. 

Parang has the pail system of waste disposal; one Christian 
and one Chinese cemetery ; one market ; its water is derived from 
Alfonso XIII springs. 

Silik (municipal district) is inhabited by Christians and non- 
Christians. The former use the Antipolo system, the latter de- 
fecate in the rivers and streams. 

Pikit-Pagalungan {municipal district). — One female district 
nurse is undertaking obstetrical and infant welfare work. There 
exists one municipal cemetery in the district in fair sanitary 
condition. This is used by Christians only. The non- Christians 
are still following their old custom of hurrying their dead at the 
side of their house. 

Glan {municipal district) .—The Antipolo system is used in the 
agricultural colony and the pail system in Glan itself. 

Water supplies.— Cot^h^io derives its water from the distilled- 
water and ice plant ; Parang from the Alfonso XIII spring. The 
Agricultural colonies use well water, the wells of which are often 
overflooded. Cholera cases occurring during the year showed 



214 

evident infection from river water. Several artesian wells were 
drilled without satisfactory results. 

Infant welfare work is still in its infancy. District visiting 
nurses and midwives are, however, making a good, effective be- 
ginning. It is calculated that about 50 per cent of all deaths 
occurred among Christian infants under 2 years of age. It would 
probably be more appalling when the non-Christian deaths are 
recorded. It is hoped that the appointment of more district 
visiting nurses and midwives to cooperate with women's clubs 
will decrease this mortality rate. 

DAVAO. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Cases. 

4. Malaria 900 

171. Traumatism by cutting or piercing instruments 297 

145. Other diseases of the skin and annexa 234 

187. Ill-defined organic diseases 140 

144. Acute abscess :. 126 

10. Influenza 120 

89. Acute bronchitis 103 

103. Other diseases of the stomach (cancer excepted) 97 

73. Neuralgia and neuritis 75 

Municipal sanitation. — The municipality of Davao uses the 
pail system of waste disposal. The excreta is deposited in a 
large pit of the Antipolo system plan. The establishment of 
the Antipolo system is being taken up in Davao, Mati, Manay, 
Caraga, Baganga, Cateel, Santa Cruz, and in the municipal dis- 
tricts. 

The municipality of Davao has one permanent market and one 
slaughterhouse. There were neither markets nor slaughter- 
houses in the municipal districts. 

In the town of Davao rain water stored in tanks is used for 
drinking purposes, while in the barrios, spring and stream water 
is used. In the other municipalities well or river water is used. 
There is a plan for the establishment of a water supply system. 

At Davao garbage is collected regularly and disposed of or 
burried in a big pit. In other towns there is no regular collec- 
tion of garbage but the people were obliged to collect and burn 
their own garbage on their premises. 

There was one district nurse at Davao and one midwife at 
Mati engaged in infant welfare work. 

Inspection of schools was performed regularly by health officers 
or graduate nurses. 



215 

The Health Service cooperated in the food and clean-up week 
campaigns. 

During the year 120 sanitary orders were issued; 10 prosecu- 
tions filed ; and 3 new municipal ordinances passed. 

Since 1917 general vaccination work was carried on through- 
out the province. The failure of 3 succeeding vaccinations 
among the non-Christians detracted faith from this efficient pre- 
vention and it also disposed them to hate the health personnel. 

Recommendation, — (1) Establishment of dispensaries in the 
distant municipal districts as the expenses incurred in inspec- 
tion trips are occasionally greater than that of the salary of the 
personnel for such dispensaries, and (2) drilling of artesian 
wells in the various municipal districts. 

LANAO. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Cases. 

4. Malaria 1,670 

145. Other diseases of the skin and annexa 1,388 

5. Smallpox 1,310 

103. Other diseases of the stomach, (cancer excepted) 333 

143. Furuncle 240 

171. Traumatism by cutting or piercing instruments 230 

90. Chronic bronchitis 215 

20. Purulent infection and septichaemia 201 

107. Intestinal parasites 198 

Amoebic dysentery is endemic in Lanao. It is difficult to 
convince the Maranaos that protection against intestinal diseases 
may be secured by drinking boiled v^ater. 

Malaria is prevalent all over the province, but less severe in 
the town centers. Quinine is distributed liberally as a pro- 
phylactic. Roman and Tamparan v^ere badly infected on ac- 
count of stagnant v^ater being alv^ays present in these towns. 
Enlarging the mouth of the Agus river so as to lower the water 
level of lake Lanao by at least one meter will drain these two 
places. 

Tuberculosis is very rare in Lanao. 

Disposal of excreta. — The pail system is used in Dansalan, 
Iligan, and Malabang. The Antipolo system cannot be readily 
adopted on account of lack of funds and high cost of materials. 

Cemeteries, — There are two municipal, one Roman Catholic 
and one Chinese cemeteries in Iligan, Momungan and Malabang, 
respectively. They are fenced with wire to prevent the entrance 
of animals. Dansalan has a provisional cemetery. There are 



216 

proposed cemeteries at Dansalan, Buruun and Dalipusa, one for 
each. 

Water supply, — There is one artesian well at Iligan. Dan- 
salan derives its water supply from lake Lanao. More artesian 
wells should be drilled. 

Markets and slaughterhouses, — Malabang has one market of 
mixed construction, having a cement floor and light material su- 
perstructure. The provisional markets at Iligan and Dansalan 
are kept clean. 

There are no slaughterhouses in this province. 

Medical inspection of schools, — During the year only 6 schools 
were inspected due to the smallpox and cholera epidemics engag- 
ing the time and attention of the health officers. A launch should 
be provided at lake Lanao for (1) school inspections and (2) 
for attending emergency cases in towns bordering on the lake. 

Infant welfare, — Infant mortality was not high on account of 
the infrequency of beriberi. Gastro-intestinal diseases were 
more prevalent. There is no woman's club in the province. 

The influenza epidemic was not as severe as in other provinces 
due to the high altitude, constant temperature and the sparce 
and widely scattered population of the province of Lanao. 

Vaccination, — Two remittances of vaccine virus were useless 
in the vaccination campaign as the virus was inactive. Good 
virus was received in the third remittance. This time the prov- 
ince was divided into six districts, and each district placed in 
charge of a vaccinating party, composed of a senior sanitary 
inspector, 3 or 4 vaccinators, and a Constabulary oflScer and 15 
soldiers. The units were instructed to cooperate with the datus 
in convincing the Maranaos and apprehending those who refused 
to be vaccinated in order to try them for violation of the laws 
governing vaccination. The results were very satisfactory. 
Very little opposition was encountered and not a single case was 
tried in court. 

The good virus was kept as follows: (1) Constantly in ice- 
box filled with ice (2) each party was given virus enough to last 
3 days (3) each party was provided with a thermostat bottle half 
filled with cracked ice covered with cotton (4) regularly every 
3 days they received their supply of virus and ice. 

Sanitation among non-Christians, — The water used by the non- 
Christians is mostly derived from springs, wells, rivers, and lake 
Lanao. The Maranaos defecate in the rivers and lake Lanao. 
This custom gravely endangers public health. 



217 

The Maranao markets are simple cogon roofed sheds where 
they gather on certain market days for trade. Sanitarily they 
are very unsatisfactory. 

The Maranaos used to bury the dead inside their cotta and 
near their homes. Now the majority of the barrios and ran- 
cherias have their own unfenced burial ground, generally about 
1,000 yards from the nearest dwelling house. There are plans 
for requiring these barrios and rancherias to establish next year 
cemeteries approved by the Director of Health. 

Recommendation, — What will render the best service in the 
interest of public health is the establishment of good water 
supply together with the eradication of the Maranao habit of 
defecating in rivers and streams. 

MISAMIS. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Cases. 

4. Malaria 730 

145. Other diseases of the skin and annexa 622 

10. Influenza 470 

75. Diseases of the eyes and their annexa 343 

174. Traumatism by cutting or piercing instruments 267 

144. Acute abscess 242 

27. Beriberi 143 

76. Diseases of the ears 72 

90. Chronic bronchitis 57 

107. Intestinal parasites 152 

There are 15 municipalities divided into five sanitary divi- 
sions of three municipalities each. There is a physician in 
charge of each division. In Cagayan there is a provincial 
hospital in charge of the District Health Officer and the presi- 
dent of the sanitary division. 

Beriberi is very prevalent among adults and infants in the 
island of Camiguin. This is due to the fact that imported 
polished rice forms a large part of the people's diet as the 
island of Camiguin produces a very small amount of rice and 
corn for local consumption. 

Malaria, — This disease is endemic in most of the towns of 
this province, and shows a preference to attack persons living 
in the woods in virgin territory. Liberal distribution of qui- 
nine will decrease malaria in the province. 

Tuberculosis is very prevalent in this province. 

Municipal sanitation. — The Antipolo system has been adopted 
in all the municipalities, except in Initao, Cagayan Tagoloan 
and Mambajao where the pail system is used. 



218 

During the year three cemeteries were opened, four old ones 
reopened and two closed. 

There are six permanent, nine temporary and two mixed 
material markets. Cagayan and Mambajao each have a slaugh- 
terhouse. Spring water brought in galvanized iron tubes is 
used in the island of Camiguin. River, spring, well or rain 
water is used in other towns. Cagayan has an artesian well 
4,149 pupils were inspected. The majority of the pupils have 
skin diseases, trachoma and dental caries. 

SULU. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Cases. 

4. Malaria - 6,460 

145. Other diseases of the skin and annexa 5,585 

107. Intestinal parasites '. 3,257 

171. Traumatism by cutting or piercing instruments 1,386 

89. Acute bronchitis 1,219 

103. Other diseases of the stomach (cancer excepted) 1,110 

10. Influenza 1,209 

75. Diseases of the eyes and their annexa -. 667 

118. Other diseases of the digestive system (cancer and tuberculosis 

excepted) 541 

99. Diseases of the mouth and annexa 427 

Sulu Pitblic Hospital — Improvements were made in the 
operating room of the hospital. Shower baths and laboratories 
were installed. 

Vital Statistics. — The death rate during the year shows a 
slight decrease in spite of the influenza epidemic. The infant 
mortality rate has fallen decidedly while the birth rate shows 
a slight decrease. Marriages and births were not registered 
properly. Infantile beriberi was not very common among Mo- 
ros due to the fact that even at a very tender age the infant 
is allowed such foods as banana, coconut oil, rice broth, etc. 
On the other hand morbidity from gastro-intestinal diseases 
was very high. 

Dangerous communicable diseases: 

Smallpox. Cases. Deaths. 

Sibaud 5 

Cagayan 2 

Sibalung 2 1 

One person responsible for the spreading of smallpox in 
Sibaud and Sabalung by using human secretion for vaccination 
was fined ^0. 

The cases of typhoid fever were mostly among Japanese. 
These people eat raw oysters which are known to harbor the 
bacilli. 



219 

There is urgent need for the establishment of potable water 
supply to decrease the prevalence of dysentery. 

Influenza, — In Jolo alone 1,581 cases with 11 deaths were 
registered. 

Cholera. — There is a general prevalence of this disease 
throughout the province and outside of Jolo. Besides huge 
sanitary improvement of the malarial regions, the wholesale 
distribution of quinine among the masses will tend to reduce 
malaria. 

Municipal sanitation. Disposal of excreta. — In Jolo there 
are 118 flush closets, one septic tank, 95 pails, and 314 other 
toilets. The pail system is the one approved by the munic- 
ipality of Jolo. The provincial board disapproved the Antipolo 
system on account of its being in conflict with local customs 
and religion. In nearly all parts of the province excreta is 
disposed of directly into the sea. 

Cemeteries. — Jolo has five cemeteries (Roman Catholic, 
Japanese, Chinese, Mohammedan, and municipal) and Siasi has 
one Roman Catholic and one Chinese cemetery. 

Markets. — There are two cement markets in Jolo, with two 
tanks for washing. They are kept in good sanitary condition. 
Parang has one cement market. In nearly all districts and 
barrios there are provisional markets where the people trade 
on certain market days. There are about fifty such provisional 
markets. 

There is one slaughterhouse in Jolo. 

Water supply. — Jolo is supplied with potable water from 
springs at Asturias and brought to Jolo by cement tubing and 
distributed to the homes. There are 3 pump wells. Besides, 
distilled water is available in Jolo. Siasi also is supplied with 
spring water piped to the town. In other towns well water is 
used. The province is well supplied with springs and they should 
be availed of by proper piping to the towns. 

School inspection. — Every school child in Jolo, Siasi and 
Lapak has been inspected and sick school children were treated. 

Infant welfare. — Ninety-nine infants under 2 years of age 
have been admitted in the Sulu Public Hospital. The Jolo 
Woman's Club devotes its activities to infant welfare work as 
well as to the home garden campaign. Publicity work in behalf 
of public health, food campaign, and clean-up week were some of 
the other side activities of the Health Service at Sulu. 

Vaccination. — Thirty-nine persons were inoculated with 
Shanghai Vaccine, with 29 positives or 74 per cent ; 25 persons 
were inoculated with Saigon vaccine, with 12 positives or 48 



220 

per cent. The value of vaccine is being gradually appreciated 
by the Moros. The cooperation of ''datus'' and ''panglimas'* 
and the employment of Moros as vaccinators together with 
persuasion aided in extending the vaccinated campaign. 

SURIGAO. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

4. Malaria 144 

10. Influenza 80 

107. Intestinal parasites 71 

14. Dysentery 50 

145. Other diseases of the skin and annexa 26 

54. Anaemia chlorosis 22 

There are over 5,000 non-Christians inhabitants in the Prov- 
ince of Surigao belonging to the Manobos and Maranaos. They 
live in the municipalities of Surigao, Placer, Cantilan, Tandag, 
Lianga and Hinatuan separate from the Christian population. 
With the exception of teachers acting as sanitary inspectors, 
in the non-Christian barrios, no other sanitary steps have been 
taken among the non-Christians. It is recommended that 3 
sanitary inspectors be especially detailed to work among them 
and that 3 non-Christian pupils be sent as pensionados to study 
sanitation. 

Among the Christian population, there is a group called the 
"Colorums'' living in the mountains and given to fanatic beliefs 
and practices. 

Hospitals and dispensaries. — There is no Government hospi- 
tal in the province. There is a dispensary in each municipality 
in charge of a physician or a sanitary inspector. 

Dangerous communicable diseases, — Malaria is prevalent 
among people living outside of the towns, in the forests or on 
the low lands. The attention of these people has been called 
to these insanitary environments as a cause of the prevalence 
of malaria. In spite of this, very little cooperation or sanitary 
improvements were observed. 

From the reports it is seen that four tenths of the deaths 
were due to dangerous communicable diseases (cholera, small- 
pox, dysentery, grippe, etc.). It is recommended that any 
town in which a case of dangerous communicable disease occurs 
be declared as a cantonment zone to be under a military sani- 
tary rule enforced by a health officer as commander-in-chief. 

Disposal of excreta. — Of the 9 municipalities, Gigaquit is the 
only one not adopting the Antipolo system. It is alleged that 
the toilet tanks may contaminate the nearby wells. In Hina- 
tuan and Lianga palma brava is used for piping. 



221 

At Dapa two cemeteries have been ordered closed. 

Water supply. — At Placer a water supply system is under 
construction for which ^12,400 were appropriated. In Ba- 
cuang ^7,500 have been appropriated for its water supply. In 
Lianga ^1,900 have been spent on its water supply. A water 
system for Surigao is now under study in the district engineer's 
office. 

In Surigao 4 perforations for artesian wells gave salty water. 
It is recommended that at least pumps be provided for those 
towns obtaining their water supply from wells. 

Mai^kets and slaughterhouses, — There are four permanent 
and five provisional markets in the province. 

Infant welfare, — There is one woman's club at Surigao with 
60 members. About one third of the total deaths occurred in 
infants under two years of age. Instruction to mothers and 
free medical treatment of sick children were given. 

Vaccination, — Vaccination would have been more extensive 
if the cholera epidemic had not absorbed so much, of the time 
and attention of the health personnel. 

Miscellaneous, — The health personnel cooperated in the Li- 
berty loans and Red Cross drives, and the agricultural contest 
held by the Bureau of Agriculture. 

Recommendation. — That the sum of ^100,000 be appropriated 
for sanitary improvements in the province. 

ZAMBOANGA. 

The Province of Zamboanga has an area of 7,276 square miles 
and a population of 145,000 inhabitants, of whom 75,000 are 
Christians living in towns and 70,000 are non-Christians living 
in barrios and rancherias. 

COMMON DISEASES (AS RECORDED IN THE DISPENSARIES). 

Case. 

4. Malaria 1,172 

145. Other diseases of the skin and annexa 1,127 

10. Influenza 851 

107. Intestinal parasites 501 

171. Traumatism by cutting or piercing instruments 376 

103. Other diseases of the stomach (cancer excepted) 282 

186. Other external violence 229 

75. Diseases of the eyes and their annexa 201 

143. Furuncle 188 

69. Acute bronchitis 163 

Malaria may be found in all parts of the province, especially 
in barrios inhabited by Moros. An anti-malarial campaign was 



222 

carried out in the city of Zamboanga. Quinine was distributed 
freely among the people. 

Tuberculosis also is important in view of its prevalence. Si- 
milar measures as in other provinces are advised. 

Municipal sanitation. Zamboanga, — The pail system is used. 
The collection was done by private individuals on contract basis. 
The excreta is thrown into the sea far from the shore. 

Zamboanga itself has a Roman Catholic and a Protestant ce- 
metery. Tetuan, Ayala, and Manicaban have each a Roman 
Catholic cemetery. One municipal cemetery is under construc- 
tion for Zamboanga. Dapitan, Dipolog and Lubungan each 
have a Roman Catholic cemetery. They are all kept in good 
sanitary condition. The Moro rancherias also have some form 
of burial place. 

Markets and slaughterhouses. — Zamboanga has a market of 
strong material and cement floor. The foods offered for sale 
are placed on tables. There is always a sanitary inspector 
detailed there to inspect the food for sale. The slaughterhouse is 
located outside of the town of Zamboanga near the sea. Dipolog 
and Lubungan each have a public market. 

Water supply. — Zamboanga derives its water supply from the 
reservoir at Pa^sonanca, about four and one half miles from town. 
The water is piped to the town in iron tubes. The water is 
under constant examination and inspection. It is pure and pot- 
able water. Isabela de Basilan has a good water supply. It 
comes from the mountains from where it is led into the town by 
pipes. Here it is kept in a reservoir from which the people may 
get water through a faucet. For Dapitan, Dipolog and Lubun- 
gan the drilling of artesian wells is recommended. 

Medical inspection of school children. — In Zamboanga, Dapi- 
tan, Dipolog and Lubungan school children are examined. 

Miscellaneous. — The health personnel has participated more 
or less actively in the food campaign, clean-up week. Red Cross 
and Liberty loan drives. 

The following activities are recommended for 1919: 

(1) Increase the health personnel. (2) establish more dispensa- 
ries on the rancherias and in the Moro barrios, they being one 
of the most potent factors in attracting these people to civiliza- 
tion. (3) establishment of a sewage water disposal system in 
Zamboanga. (4) drilling of artesian wells in Dapitan, Dipolog 
and Lubungan. (5) building of a morgue in Zamboanga. 

San Ramon Penal Farm. — The medical officer arrived at the 
farm in July, 1918. Immediately anti-mosquito and anti-fly 
campaigns were started in July and August and lasted till Nov- 



223 

ember,) Another campaign against bed bugs was carried on 
among the prisoners in October. As a result of the campaigns, 
flies, mosquitoes and bed bugs were very rare by November. 

In the prison itself water from a well-cared-for pump-well is 
used. Prisoners working in the field and those living outside of 
the reservation use river or well water. 

Inside the reservation waste is disposed of by a water sewage 
system. Outside the prison the pail system is used. The Anti- 
polo system is used in buildings far out in the fields. 

One cholera suspect was detected. An examination of 150 
persons for cholera carriers gave an average of four per cent 
positives. 

General vaccination was carried out. The Saigon virus gave 
sixty-five per cent positive; the Shanghai, fifty-four per cent 
positives. 

There were admitted in the sick ward during the year 1052 
persons, with 3.61 per cent mortality. In the dispensary 1,555 
cases were recorded, with 31,117 treatments. The hospital ex- 
penses for subsistence and fuel amounted to 1P1,255.36. The 
expenses for medical and surgical supplies amounted to =^2,270.93. 
The hospital had an average of 20 patients at all times. 

XVIII. 

CONCLUSION. 

Like all missionary work, the extension of the benefit of 
health and sanitation in Mindanao and Sulu has demanded even 
the supreme sacrifice of life. Sanitary Inspector Hospicio 
Agasa was killed in Lanao during the vaccination campaign. 
Sanitary Inspector Juan Dagnaos was killed in Sulu while in- 
specting a market. They are both highly deserving of praise 
and the Government should take measures to help the dependents 
of the deceased. The fate of these two workers indicates the 
actual accidents only. In many instances physicians and sanitary 
inspectors risked their lives in the performance of their duties. 
This spirit of sacrifice indicates the high state of discipline and 
morals of the sanitary personnel of this division. 



REPORT OF THE OFFICE OF HYGIENIC AND INDUSTRIAL 
DEVELOPMENT 

[Mamerto Tianco, Acting Chief of Office.] 



ACTIVITIES. 



During the period for which this report is made the activities 
of this office were conducted along the same lines as in the pre- 
ceding year, and the work undertaken has been a continuation 
of the program instituted for the attainment of its mission as 
outlined in the report for 1916. 

CAMPAIGN FOR SANITARY DWELLINGS, PROPER HANDLING OF FOOD- 
STUFFS AND DRINKING WATER, AND PROPER DISPOSAL OF 
WASTES AT THE CARNIVAL OF 1918. 

The exhibits of the Philippine Health Service at the Carnival 
held during February, this year, were along the same lines as 
those of last year, with improvements and additions. 

This year, in addition to and in connection with the Sanitary 
Model House, household vegetable and flower gardens have been 
planted. The house was much larger than that of last year, was 
of better construction, painted and the shingles for roofing have 
been improved by widening and adding to their lower end a 
small diamond shaped protuberance which serves as a lock in 
the laying of the shingles so that leaks cannot occur. The shin- 
gles are larger, and overlap more in laying, all of which con- 
tribute to make the roof water tight. The house was much better 
furnished and appealed to a larger class of people. It had all 
the facilities which a sanitary house should have, receiving room, 
sala and sleeping room combined, bed-room proper, toilet, bath- 
room and a well arranged kitchen; the water, food, etc., handled 
in a sanitary manner, i. e., water protected from soiled hands, 
food from flies and dust, and sleeping occupants from mosqui- 
toes, etc. 

Sanitarily speaking, the house was comparable with any of 
the best managed houses in the Philippine Islands. The toilet 
was of the Antipolo system, the pipes were of vitrified clay made 
and burned at the kilns of Mr. Santiago Jimenez, San Pedro Ma- 
cati, Rizal. The waste water from the bath and kitchen were 

224 



225 

sanitarily disposed of to the toilet pit so that the grounds were 
always kept dry and clean. The uncleanly and unsightly 
'^pusalian'' generally seen under the provincial houses has been 
done away with. 

In the house a ''balanced diet'' was exhibited and a nurse an- 
swered all inquiries as to the method of its cooking, its consti- 
tuents and values, and practical demonstrations were given at 
convenient times. The idea was to induce the people to adopt 
a type of diet which will give all the essential substances neces- 
sary for a well nourished body. It was also aimed in this part 
of the exhibit to create in the minds of the people the necessity 
of helping to conserve the food supply by a wise economy in food 
consumption. 

The home gardens which were made a part of the exhibit was 
a practical demonstration of how such things can be conducted 
in almost every home of the Archipelago. The vegetable garden 
contained, cabbage, petchay, beans, mongo, peas, beets, endive, 
okra, pepper, egg-plant, sweet potatoes, etc. Such a garden 
will not only reduce expenses as to food but will produce some 
revenue to the house-owner as well. The fence was also made 
sanitarily, the bamboo knots are barred so that they will not hold 
water, thereby eliminating mosquito breeding places. 

CHILD WELFARE WORK. 

The organization of women's clubs for child welfare work has 
been given great impetus during the year, and we have now a 
chain of 233 such clubs from Batanes and Aparri to Jolo, Davao 
and Cotabato, of which 157 were established during the year. 
Nineteen puericultural centers were also organized and thirty- 
eight baby contests held during 1918. All in all, great progress 
was effected in child conservation work. 

Women's clubs were established in the following towns during 
the year 1918; 

Albay : 

Viga, Virac. 
Ambos Camarines: 

Buhl, Bula, Cabusa, Calabanga, Camaligan, Gainza, Goa, Indan, 
Labo, Lagonoy, Libmanan, Mambulao, Milaoi*, Minalabac, Naga, 
Pasacao, Pill, Sagnay, San Jose, San Vicente, Sipocot, Sirimu, 
Talisay, Tigaon, Tinambac. 
Benguet : 

Baguio. 
Batanes : 

Itbayat, Mahatao. 
Batangas : 

Lipa, Tanauan, Nasugbu. 

168426 16 



226 

Bohol: 

Loon, Bilar, Jagna, Maribojoc. 
Bulacan : 

Bocaue, Bustos, Hagonoy, Guiguinto, Pandi, Pulilan, San Miguel, 
Marilao, Meycauayan, Norzagaray, Paombong, Polo, Quingua, 
San Rafael. 
Cagayan : 

Alcala, Aparri, Ballesteros, Iguig, Lallo, Solana, Tuao, Tuguegarao. 
Cebu: 

Argao, Balamban, Barili, Bago, Carcar, Tuburan, Bantayan, Cebu, 
Dalaguete, Dumanjug, Malabuyok, Sibonga. 
Cotabato : 

Cotabato. 
Davao : 

Davao. 
Ilocos Norte: 

Solsona, Bacarra, Badoc, Bangui, Batac, Burgos, Dingras, Laoag, 
Paoay, Pasuquin, Piddig, San Nicolas, Sarrat, Vintar. 
Ilocos Sur: 

Santa Lucia, Cabugao, Vigan. 
Iloilo: 

Leon, Arevalo, Miagao, Oton, San Joaquin, Tigbauan. 
Isabela : 

Cabagan. 
La Union: 

Agoo, Caba and Luna. 
Leyte: 

Tacloban, Palompon. 
Misamis : 

Isabela, Mambajao. 
Nueva Ecija: 

Aliaga, Gapang, Jaen, San Isidro, Pantabaygan, Catabangan, Ba- 
gabag, Lupao. 
Nueva Vizcaya: 

Bayombong, Dupax, Dupax (Aritao), Bagabag and Antao. 
Occidental Negros: 

Bacolod, Bago, Binalbagan, Himamaylan, Hog, Hiniguan, Isabela, 
Cabancalan, La Carlota, Pontevedra, Valladolid, Cadiz, Palu- 
pandan, Saravia. 
Oriental Negros: 

Dumaguete. 
Pangasinan : 

Binmaley, San Carlos, Malasiqui, Labrador, Tayug. 
Palawan : 

Puerto Princesa. 
Pampanga : 

Bacoor, Macabebe, Candaba. 
Romblon : 

Corcuera, Bantasua, Banton, San Fernando. 
Samar: 

Buiuan, Calbayog. 
Sorsogon : 

Gulas, Gubat. ^' . 



227 

Tayabas : 

Sariaya, Infanta. 
Zamboanga : 

Zamboanga. 
Zambales : 

Masinlac, Iba. 

The organization of women's clubs throughout the provinces 
during the year 1918 compares very favorably with previous 
years, showing an increase of* 132 per cent over 1916 and 155 
per cent over 1917. 

The following associations for the protection of early infancy 
were incorporated during the year 1918 : 

Bulacan : 

Malolos, Centre de Puericultura. 
Cebu: 

Catmon, Centro de Puericultura. 
Laguna : 

Majayjay, Centro de Puericultura. 

San Pablo, Centro de Puericultura. 

Santa Cruz, Centro de Puericultura. 
Leyte: 

Palompon, Asociacion de la Proteccion de la Infancia de Palompon. 
Misamis : 

Mambajao, Centro de Puericultura. 
Negros Occidental: 

Silay, Circulo Femenil. 

San Carlos, Centro de Puericultura. 

Binalbagan, La Salvacion de la Infancia. 
Pampanga : 

San Fernando, Club de Dama Fernandina para la Proteccion de la 
Infancia. 
Pangasinan : 

Asingan, Centro de Puericultura. 

Lingayen, Centro de Puericultura. 
Samar : 

Guiwan, Centro de Puricultura. 
Tayabas : 

Infanta, Centro de Puericultura. 

Boac (Marinduque), Centro de Puericultura. 

Santa Cruz (Tayabas), Centro de Puericultura. 

Mogpoc and Man di jay, Centro de Puericultura. 
Zamboanga : 

Zamboanga, Centro de Puericultura de Zamboanga. 

The number of associations for the protection of early in- 
fancy incorporated during the year 1918 shows a decrease of 
24 per cent as compared with 1917. 

CAMPAIGN FOR IMPROVING DIET. 

The diet of the average Filipino has been found deficient, 
and as a consequence thereof, the majority of the people are 



228 

under-nourished. The quantity of food may be sufficient but 
the quality and variety may be insufficient for the needs of 
the body. Work toward the improvement of the dietary of the 
Filipino people has been endorsed to the existing women's clubs. 
Practical demonstrations on the subject were given at the Car- 
nival and a bulletin dealing with a balanced diet for thirty days 
was issued, under the direction of the Director of Health, during 
the year. 

CAMPAIGN FOR BETTER FECAL DISPOSAL. 

With regard to the campaign for better fecal disposal in the 
provinces, it is noteworthy that the office has succeeded in 
having 3,900 unglazed, vitrified clay pipes for closets of the 
Antipolo system, made locally at a cost of fifty centavos each, 
which if imported would have cost ^4.50 a piece. The local 
product means a reduction of 400 per cent from the cost of the 
foreign-made pipes, and such an achievement spells great possi- 
bilities for wider use of the Antipolo plan of sewage disposal 
as well as for local production of materials for general plumbing 
work. 

As a net result of this campaign in the provinces for better 
fecal disposal, a total of 38,454 new closets of the Antipolo 
system were installed during the year — these with the number 
in operation at the close of the year 1917 — 32,274 — ^make a 
grand total of 70,728 Antipolo closets in operation at the end 
of 1918. 

HOME GARDENS. 

The campaign for the establishment of home gardens has 
been continued and in connection with the campaign for food 
production undertaken by all concerned, especially by the Bu- 
reau of Agriculture, Bureau of Education, and local authorities 
have resulted in the following: 

Total promises to plant home gardens 295,802 

Number of persons to whom seeds were distributed 93,518 

Number of home gardens actually planted 330,462 



REPORT OF THE OFFICE OF SANITARY ENGINEERING 

[Edward L. Barber, Sanitary, Engineer,] 



The work of this office may be divided into the following 
sections : 

1. Sanitary supervision of building construction, city of Ma- 
nila, 

2. Execution and enforcement of structural sanitary orders, 
including all orders for filling in low lands, city of Manila. 

3. Plumbing installation and inspection, city of Manila. 

4. Sanitary and construction projects, provincial. 

5. Drafting department. 

6. Construction work, city of Manila. 

7. Construction work, Culion Leper Colony. 

MANILA. 

There is appended hereto a tabulation showing the amount 
of routine work performed in the city of Manila and the prov- 
inces. During the year 546 sanitary orders were issued, sub- 
divided under the following heads : Minor orders, sewer orders, 
vacating orders, and filling orders; a total of 525 orders were 
completed; 77 separate projects were handled in the drafting 
bcction and 933 blue-prints were made from various tracings; 
building projects to the number of 2,972 were acted upon; and 
728 separate plumbing projects were handled in this office, the 
total cost of the latter amounted to ^205,301.95. 

PROVINCIAL. 

The following provincial trips were made: 

1. Sariaya, Tayabas, to inspect the proposed sewer system. 

2. Culion, Palawan ; two trips were made, the first for laying 
out a program of construction work for the year 1918 and the 
second for a conference with the chief of the colony regarding 
construction appropriations. 

3. San Pablo, Laguna, to inspect reconstruction of the carni- 
val model house. 

229 



230 

Statistical information by districts. 

[Manila only.] 



Orders pending December 81, 1917 - 



Orders issued: 

Minor orders 

Sewer orders 

Vacating orders . 
Filling orders 



Total - 



Grand total. 



Orders completed: 

Minor orders 

Sewer orders 

Vacating orders _ 
Filling orders 



Total 



Orders cancelled: 

Minor orders 

Sewer orders 

Vacating orders - 
Filling orders 



Total . 



Grand total . 



Orders pend'ng December 31, 1918: 

Minor orders 

Sewer orders 

Vacating orders 

Filling orders 



Total . 



Health districts- 



No. 1. No. 2. I No. 4. No. 5. No. 6. Total. 



33 



224 ! 36 

52 ! 7 

88 ! 5 

1 ' 46 



315 



94 



286 



57 



423 



225 
47 
56 

1 

329 



83 



15 ! 

72 1 
4 I 



19 I 
31 



347 
75 
75 
49 



335 
63 

70 
57 



525 



47 
110 
50 



302 



231 



Stat'iBtical information by quarters. 

[Manila only.] 



Orders pending Deember 31. 1917^ 



Orders issued: 

Minor orders 

Sewer orders 

Vacating orders . 
Filling- orders 



First i Second 
quarter, quarter. 



j Third | Fourth 
j quarter. ; quarter. I 



Total. 



Total, 



Grand total _ 



Orders completed: 

Minor orders 

Sewer orders 

Vacating orders 

Filling orders 



Total. 



Orders cancelled: 

Minor orders 

Sewer orders 

Vacating orders . 
Filling orders 



143 
14 
21 
44 



43 

21 I 
24 

4 I 



92 I 



95 



347 
75 
75 
49 

546 



832 



126 


62 


57 


21 


8 


17 


21 


11 


29 


13 


21 


8 


181 


102 


111 



Total. 



Grand total . 



Orders pending December 31, 1918.. 

Minor orders 

Sewer orders 

Vacating orders -.. 

Filling orders 



Total - 



2| 



las 



103 I 113 



335 
63 
70 
57 



530 



47 
110 
50 
95 



302 



Statistical .information by districts. 

[Manila only.] 



Strong material plans approved: 

New buildings including additions and altera- 
tions 

Permits for minor building construction: 

Approved 

Disapproved 

New buildings completed 

Light and mixed material structures: 

Permits approved 

Permits disapproved 



Total number of building projects passed 
upon 



Health districts- 



No. 1. No. 2. No. 4. No. 5. No 6. Total 



145 
35 
40 



39 
7 
14 

284 
141 



18 
12 
12 

724 
391 



1,235 



91 

31 
5 
11 

240 
114 



492 



291 
77 
91 

1,248 
646 



3,044 



Note.— Tl»*rty-two cases of ilegal construction were reported to the city engineer, five of 
which were reported according to ordinances. 



232 



Statistical information by quarters. 

[Manila only.] 



Strong material plans approved: 

New buildings, including addition and alte- 
ration 

Permits for minor building construction: 

Approved.-- — — 

Disapproved 

New buildings completed 

Light and mixed material structures: 

Permits approved __ 

Permits disapproved 

Total number of building projects passed 
upon 



First 
quarter. 



133 

71 
24 
20 

221 
134 



603 



Second 
quarter. 



148 

67 
14 
19 

644 
159 



951 



Third 
quarter. 



168 

72 
30 
18 

275 

204 



Fourth 
quarter. 



170 

81 

9 

34 

208 
149 



651 



Statistical information by districts. 

[Manila only.] 





Health districts- 




No. 1. 


No. 2. 


No. 4. 


No. 5. 


No. 6. 


Total. 


Plumbing permits issued 

Plumbing projects completed 


148 
135 


396 
339 


127 
112 


89 
81 


68 
61 


828 
728 








Premises connected to the sanitary 

sewer to January 1, 1918 

Premises connected during 1918 


1,314 
30 


2.251 
95 


791 
26 


329 
U 


296 
10 


4,981 
172 


Total December 31, 1918 


1.344 


2.346 


817 


340 


306 


5,153 







Statistical information by quarters. 

[Manila only.] 





First 
quarter. 


Second 
quarter. 

246 
196 


Third 
quarter. 


Fourth 
quarter. 


Total. 


Plumbing permits issued __ . 


183 

184 


187 
153 


212 
195 


828 


Plumbing projects completed 


728 






Premises connected to the sanitary sewer to 
January 1, 1918 - 










4981 


Premises connected during 1918 __ 


43 


42 


36 


51 


172 






Total December 31. 1918 










5,153 




1 









Statistical information by districts, 

[Manila only.] 





Health district. 


Prosecutions. 




Convic- 
tions. 


Dismis- 
sals. 


Amount 
of fines. 


Intramuros 




3 
2 


1 

1 


P45.00 


Meisic 


35.00 


Sam pal oc 




Tondo . _._ . - --. 




1 




Paco 
















Total -- 


5 


3 


80.00 







233 

Statistical information by qttarters. 

[Manila only.] 





Quarter. 


Prosecutions. 




Convic- 
tions. 

1 


Dismis- 
sals. 


Amount 
of fines. 


First 


P25 00 


Second 


3 




Third 






Fourth 


4 




56 00 












Total 


5 3 


80 00 








DRAFTING PROJECTS. 

Project No. 

1,23. Portfolio map (Manila), 65 per cent completed. 
6. Blue printing, at intervals. 
43. Work report, completed at the end of every month. 
324. Maximum and minimum temperature taken daily from January, 1911, 

continuous. 
385. Correcting Health Bulletin No. 16, 95 per cent completed. 
408. Plan of map file for the office of Sanitary Engineering, 100 per cent 
completed. 

419. Sketch for the Quarantine Station and organization, 100 per cent 

completed. 

420. Estimating materials of roof of Christian chapel for Culion Leper 

Colony, 100 per cent completed. 

421. Remeasuring municipal golf course, 100 per cent completed. 

422. Reducing plan and sectional views of a squatting closet, 10 per cent 

completed. 

423. Signs for 1918 Carnival, 100 per cent completed. 

424. Re-tracing plan of Imhoff tank for the standard provincial toilet, 100 

per cent completed. 

425. Diagram showing provincial cholera cases, July to December, 1917, 

intervals. 

426. Diagram of six different diseases — tuberculosis, diphtheria, dysentery, 

typhoid and paratyphoid, and malaria, 100 per cent completed. 

427. Computations for new general Culion survey, 90 per cent completed. 

428. New general topographical map of Culion, scale — 1:2000, 30 per cent 

completed. 

429. Social building for women's club, Cabanatuan, Nueva Ecija, 100 per 

cent completed. 

430. Description and sketch of improved concrete shingle, 100 per cent 

completed. 

431. Continuation of diagram showing cases and deaths of different con- 

tagious diseases (intervals). 

432. Tenement house for Culion Leper Colony, 100 per cent completed. 

433. Sketch of simple scarifier for vaccination, 100 per cent completed. 

434. Latest map of health districts and subdistricts (Manila), 100 per cent 

completed. 

435. Plan of sterilizer and pasteurizer for small dairies, 100 per cent 

completed. 

436. Reestimating bill of materials for Christian chapel, Culion Leper 

Colony, 100 per cent completed. 



234 

437. Clerks* quarters, Culion Leper Colony, 100 per cent completed. 

438. Model plan of cemeteries, 100 per cent completed. 

439. Enlarging section of Jflush valve, 100 per cent completed. 

440. Christian chapel (new plan), Culion Leper Colony, 100 per cent 

completed. 

441. Addition to model house plan for San Pablo, Laguna, 100 per cent 

completed. 

442. Proposed reinforced concrete (second floor addition to General Hos- 

pital), Culion Leper Colony, 70 per cent completed. 

443. Notification cards for contagious diseases, 100 per cent completed. 

444. Diagram of smallpox epidemic, (Manila), 1918, intervals. 

445. Modern standard plumbing fixtures (adapted from catalogue designs), 

100 per cent completed. 

446. Revising estimate of garbage crematory prepared by the Bureau of 

Public Works, 100 per cent completed. 

447. Sketch showing directions for pasteurizing, 100 per cent completed. 

448. Detail of manhole covers "20-24" diameter, 100 per cent completed. 

449. Signs for San Lazaro Hospital, 100 per cent completed. 

450. Alteration to Project No. 420, 100 per cent completed. 

451. New proposed tile, 100 per cent completed. 

452. Detail of steel cap for long chords support of roof of Christian chapel, 

Culion Leper Colony, 100 per cent completed. 

453. Portable seat cover of sanitary fly proof pail, 100 per cent completed. 

454. Preliminary data for the design of contagious disease hospital, 100 

per cent completed. 

455. General plumbing fixtures and recognized house drainage, intervals. 

456. Proposed contagious disease hospital, 50 per cent completed. 

457. Location of public midden sheds, at intervals. 

458. Tape measurement at interior construction, No. 352 San Marcelino, 

100 per cent completed. 

459. Alterations to Philippine Health Service regulations governing the 

uniforms of officers and employees, 100 per cent completed. 

460. Estimating bill of materials for social building Cabanatuan, Nueva 

Ecija, 100 per cent completed. 

461. Diagram showing organization of Cantonment Camp, 100 per cent 

cmopleted. 

462. Typical arrangement of sewers for three regiment group of buildings, 

100 per cent completed. 

463. Sign for office of property, 100 per cent completed. 

464. Proposed camp for National Guard Engineering Corps, 100 per cent 

completed. 

465. Extra Cantonment Zone, Paranaque, Rizal, 100 per cent completed. 

466. Map (Manila) showing permanent and temporary low lands, at 

intervals. 

467. Banner for the 4th Liberty Loan parade, 100 per cent completed. 

468. Computing areas of low lands (Manila), intervals. 

469. Tracing map of proposed site for trains (Camp Claudio), 100 per 

cent completed. 

470. Drawing for health bulletin No. 19, 100 per cent completed. 

471. Reestimating Bill of materials for new plan of Christian chapel, 

Culion Leper Colony, 100 per cent completed. 

472. Alteration to project No. 407, 100 per cent completed. 

473. Computing areas of health districts,. 100 per cent completed. 



235 

474. Preliminary sketch of layout (Proposed sanitary barrio for mining 

camp, Cebu, Cebu), 100 per cent completed. 

475. Leveling and measuring at Pandacan, Beata, for a sanitary barrio, 

100 per cent completed. 

476. Sign for the district health officer. Extra Cantonment Zone, 100 per 

cent completed. 

477. Plan of settling tank for copra meal waste, 100 per cent completed. 

478. Sketch of shelves for filing cases, 100 per cent completed. 

479. Drawings for Philippine Health Service Almanac, 100 per cent 

completed. 

480. Tracing of standard water closets, urinals, sinks, laundry tray and 

bath tubs, 100 per cent completed. 

481. Sketch of additional construction to Mary Chiles Hospital, 100 per 

cent completed. 

482. Tape measurement at 360-362 Calle Legarda, 100 per cent completed. 

483. Reestimating bill of materials, social building for Cabanatuan, Nueva 

Ecija, 100 per cent completed. 

484. Tape measurements at 423-453 Calle Pinpin, 100 per cent completed. 

485. Reducing diagram showing mortality of the city of Manila by months 

and from all causes, 1901 to 1914, 100 per cent completed. 

486. Organization chart of personnel, Philippine Health Service, Extra 

Cantonment Zone, 100 per cent completed. 

487. Chart showing decrease of smallpox death rate due to vaccination, 100 

per cent completed. 

488. Standard plans for strong material houses, 20 per cent completed. 

489. Plan of smokeless Chinese stove, 50 per cent completed. 



REPORT OF THE OFFICE OF DISTRICT NURSING 
[Mabel F. Dobbs, Acting Chief of Office.] 



There has been little change in the nature of the work from 
that of previous years. As we cannot begin to meet the actual 
great needs of the people, due to our limited staff, our work 
has been chiefly educational. Our plan is to visit each house in 
a district and treat the simple cases and refer the more serious 
ones to hospitals and clinics. Talks are given in each home on 
sanitation, housekeeping and balanced diets, expectant mothers 
are advised and instruction is given in the care of babies. Em- 
phasis is given to the subject wherein education is apparently 
most needed in each household. The family is also instructed 
how to care for the sick in the homes and to use the necessar^^ 
precautions in infectious diseases. 

The people have appreciated our efforts and have taken in- 
terest in the instructions given them, which in many cases 
have been contrary to the customs of generations. So we feel 
that we are gaining, slowly but surely, the confidence of the 
people. 

In the city of Manila our work has been in the districts of 
Tondo, Binondo, San Lazaro, and Intramuros. 

During the months of June and July we assisted at San La- 
zaro Hospital in the smallpox epidemic and a part of our staff 
remained there during August and the first part of September. 

Demonstration in balanced diets and the preparation of food 
were given at the model house at the carnival similar to those 
of the two previous years. 

Similar demonstrations were given to the nurses of the hos- 
pitals at Baguio, Bontoc, Kiangan, and Bayombong. Instruc- 
tions were given to the people in the barrios along the trail 
between these towns. 

Miss Bruchmiller, traveling nurse, had charge of the nursing 
in the infant mortality work of the sanitary survey in Cebu 
and Bulacan provinces. 

Miss Clark, chief district nurse, made an inspection trip to 
the hospitals of Baguio and Bontoc during the months of Sep- 
tember, October, November, and December. 
236 



237 

Since October we have directed all of our efforts to the work 
in the extracantonment zone of Camp Claudio, working in the 
towns of Pasay, Paraiiaque, Las Pifias, and Bacoor. In Pasay, 
in addition to our regular work, we were able to examine the 
school children and to treat simple cases. 

The female tenderas in the towns of Pasay, Paraiiaque, Imus, 
Pasig, San Juan del Monte, and San Felipe Neri were examined, 
given health certificates and instructed in methods of clean- 
liness. 

Tabular report. 



Manila 

Provinces - 

Total 



First 
visits. 


Subse- 
quent 
visits. 


Treat- 
ments. 


Referred 
to clinics. 

94 


School children. 


Exam- 
ined. 


Treat- 
ments. 


4,936 
2,349 


4. 856 
547 


5,715 
1.076 

6,791 


586 


768 
768 




7,285 


5,403 


94 1 586 

1 



Tinderas 
examined 
and in- 
structed. 



265 
265 



REPORT OF CLERICAL OFFICE 
[M. J. Walsh, Chief Clerk.'} 



The clerical office which comprises the office of the chief clerk, 
record section and financial section, commenced the new year 
with thirty-one employees ; during the year seven of these trans- 
ferred or resigned, eight new employees being appointed to fill 
their places. 

The work of handling the correspondence of the Service dur- 
ing the year was increased considerably in volume over that 
of last year and occasioned considerable overtime by the em- 
ployees to keep up to date. 

A total of 151,000 pieces of mail matter were handled by the 
office during the year. Over 40,000 letters, reports, bulletins, 
etc., were received, 16,000 letters filed and 95,000 letters, re- 
ports, bulletins, etc., mailed. 

During the year it was found that white ants had destroyed 
some of our wooden filing sections and a few of the papers filed 
therein, fortunately they were discovered in time to prevent 
the destruction of a large portion of our files. 

We eventually got rid of the white ants by washing and dis- 
infecting the filing cases and fumigating the papers, but some 
of the wooden cases were so eaten up that it became necessary 
to replace them. A set of new allsteel filing cases were bought 
and have been installed. 

238 



REPORT OF THE PROPERTY OFFICE 

[B. D. BURHAM, Chief of Office,^ 



During the year four hundred and twenty-two general requi- 
sitions were received and filled, originating from the following 
stations : 

Provincial requisitions 103 

Health stations 118 

Office of Sanitary Engineering 34 

Culion Leper Colony 29 

Department of district nursing 20 

Central Office 16 

Disinfecting squad 15 

Baguio Hospital 15 

San Lazaro Hospital 14 

Sibul Springs Sanatorium 17 

Bontoc Hospital 11 

Cuyo Hospital 10 

Bayombong Hospital 6 

Kiangan Hospital 5 

Extra Cantonment Zone 4 

Philippine General Hospitial 2 

Bureau of Supply 1 

Hospital Ship "Busuanga" 1 

Division of Sanitation, city of Manila 1 

Total 422 

Two hundred and twenty-two requisitions were prepared and 
forwarded to the Bureau of Supply for delivery to the following 
stations : 

For delivery to office of property 121 

For delivery to San Lazaro Hospital 46 

For delivery to Health Station No. 2, Meisic 3 

For shipment to Culion Leper Colony 27 

For shipment to Baguio Hospital 12 

For shipment to Cuyo Hospital 8 

For shipment to Bontoc Hospital :........ 6 

For shipment to Provincial Sanitary Commission 2 

Total 225 

One hundred and nineteen requisitions were prepared and 
forwarded to the Bureau of Printing. 

239 



240 

Orders for general supplies prepared under the direct order 
and payment system, 225. 

Forty-two commissary requisitions were received filled, origi- 
nating from the following stations: 

San Lazaro Hospital 17 

Culion Leper Colony 14 

Baguio Hospital 9 

Cuyo Hospital 2 

Total 42 

Commissary requisitions forwarded to the Bureau of Supply : 

For Culion Leper Colony 33 

For San Lazaro Hospital 20 

For Baguio Hospital 7 

For Cuyo Hospital 6 

For Office of property 5 

For Bontoc Hospital 2 

Total 73 

Orders for commissaries prepared under the direct order and 
payment system: 

For Culion Leper Colony 225 

For San Lazaro Hospital 225 

For Baguio Hospital 75 

For Cuyo Hospital 50 

Total - 575 

Miscellaneous orders prepared, 128. 

Orders prepared for Culion merchandise account, 247. 

Vaccine report. 

Units. 

On hand January 1, 1918 11,250 

Received during the year 5,145,250 

Total to be accounted for 5,156,500 

Issued during the year 5,135,400 

Remaining on hand December 31, 1918 21,100 

Requisitions for vaccine virus received and filled 3,391 

Shipments made by boat 289 

Shipments made by railroad 157 

Total 446 



241 

Inter-bureau vouchers and bills received and passed by the 
office of property: 



Bureau of Supply 

Bureau of Prisons 

Bureau of Printing 

Bureau of Science 

Bureau of Public Works 

Bureau of Posts _. 

Bureau of Forestry 

Bureau of Coast and Geodetic Survey 

Division of Cold Storage 

Philippine School of Arts and Trades 

Quarantine Service 

Open Market 

Total 



Number. 



627 
19 
17 
19 
14 
6 
1 
3 
12 
7 
1 
499 



P294. 
2. 
21. 
45. 



150, 



305. 33 
376. 89 
036. 14 
126.67 
202.47 
800.00 
2.00 
38.40 
875.76 
304.50 
840. 70 
288.96 



1.225 521.196.82 



168426- 



-16 



STATISTICAL TABLES. 
Philippine Health Service. 



JANUARY 1 TO DECEMBER 31, 1918. 



243 



GENERAL STATISTICS 

[Unless otherwise stated these statistics are for the fiscal year from January 1 to December 

31, 1918.J 

POPULATION OF THE CITY OF MANILA. 

[Health Census of 1914. J 
BY NATIONALITIES. 



Population. 



Nationality. 



Male. Female. 



Americans ; 3,584 

Filipinos -i 125»730 

Spaniards -| 2,414 

Other Europeans -~. - i 1,027 

Chinese 15.235 

All Others - - U407 

Total... 149,397 

BY DISTRICTS. 

Health districts. I 

I Male. 



1.890 

111.210 

1,992 

479 

1.422 

553 



117,546 



Total. 



5.474 
236. 940 
4,406 
1,506 
16,657 
1,960 



266.943 



Population. 



.|_.. 



No. 1. Intramuros 

No. 2, Meisic 

No. 4, Sampaloc ._ 

No. 5, Tondo 

No. 9, Paco 

Total 



18,467 
57, 121 
22, 856 
36, 520 
14,433 



149, 397 



Female. 



13, 586 
32,943 
21,367 
35,279 
14,371 



117,546 



Total. 



32.053 
90,064 
44,223 
71. 799 
28.804 



266.943 



MARRIAGES BY AGE. i 



Males. 


Num- 
ber. 


To 14 
years. 


To 20 
years. 


1 

To 25 
years. 


females 

To 30 
years. 








Age. 


To 40 
years. 


To 50 
years. 


Over 50 
years. 


To 14 vparB 








637 

1,142 

418 

276 

97 

45 


6 
3 
3 




553 

783 

207 

87 

14 

1 


66 
266 
110 
65 
20 
3 


7? 

73 
58 
20 

7 


3 
18 
24 
59 
34 
25 






To 2.'> vears 


1 
1 
6 

8 

7 

23 




To 30 years . 




To 40 vears 


1 


To 50 vears 


1 




2 






Total --- -- 


2,615 


12 


1.645 


530 


238 


163 


4 







Nationality. 



Americans 

Filipinas 

Spaniards 

Other Europeans 

Chinese 

All others 

Total and average 





Male. 



59 
4,524 
32 
29 
151 
22 


Annual 
birth rate 
per 1.000. 

16.46 
35.98 
13.25 
28.23 
9.91 
15.63 


Female. 

55 
4.006 
31 
28 
133 
13 


Annual 
birth rate 
per 1,000. 


Total. 

114 

8,530 

63 

57 

284 
35 


Annual 
birth rate 
per 1,000. 




29.10 
36.02 
15.56 
58.45 
93.53 
23.50 


20.82 




36.00 




14.29 
37.84 




17.04 




17.85 








4,817 


32.24 


4,266 


36.29 


9,083 


34.02 







1 Registration incomplete. 



245 



246 



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'V 

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247 



BIRTH, BY DISTBICTS. ^ 



Health districts- 



No. 1, Intramuros 

No. 2, Meisic 

No. 4. Sampaloc.- 

No. 5, Tondo 

No. 6. Paco 

Total 



Lefiritimates. 



Male. 



765 

1,543 

562 



4.543 



Fe- 
male. 



659 
782 
705 
1,339 
544 



4,029 



Total. 



1,454 
1,670 
1.460 
2,882 
1,106 



8,672 



Illegritimates. 



Male. 



Fe- 
male. 



Totel. 



162 
98 
101 
133 
27 



Grand 
total. 



' Annual 
birth rate 
per 1,000, 



1,606 
1.768 
1,661 
8.015 
1.133 



60.10 
19.68 
36.29 
41.99 



34.02 



Births attended by 

Physician 

Midwife 

Family 




Still- 
births. 



213 
29 
236 



^ Registration incomplete. 
BIRTHS, ACOORDIliG TO NUMBER OF CHILDREN BORNE BY MOTHER. 



Number of births in the order in 

which the child was born, whether 

first child, second child, etc. 


Living. 


Stillborn. 


Grand 


Male. 


Female. 


Total, 


Male. 


Female. 


Total. 


total. 


First -- 


1,092 

797 

651 

550 

463 

324 

286 

212 

150 

109 

69 

44 

27 

20 

13 

4 

1 

1 


922 

707 

590 

511 

385 

319 

263 

203 

118 

93 

71 

24 

26 

17 

6 

6 

2 

2 

1 


2.014 

1,504 

1,241 

1.061 

848 

643 

549 

415 

268 

202 

140 

68 

53 

37 

19 

10 

3 

3 

1 

1 


71 

36 

35 

18 

28 

19 

18 

10 

14 

13 

6 

5 

3 

1 


40 
22 
24 
21 
23 
18 
19 
14 
9 
3 


Ill 

68 

59 

39 

51 

37 

37 

24 

23 

16 

9 

5 

6 

2 


2,125 


Second ..- _. 


1,662 


Third 


1,300 


Fourth 


1,100 


Fifth - 


899 


Sixth -. 


680 


Seventh 


586 


Eighth -- - -- 


439 


Ninth _. 


291 


Tenth ._ 


218 


Eleventh 


149 


Twelfth 


73 


Thirteenth 


3 

1 


69 


Fourteenth 


39 


Fifteenth 


19 


Sixteenth 








10 


Seventeenth . . _. 








3 


Eighteenth 










Nineteenth _. 










Twentieth 


1 





1 


1 




Twenty-first 








Twenty-second 


1 

1 




1 
1 










Twenty- third _. _ 













Twenty-fourth 












Twenty-fifth 


i 




i 






478 










201 




Total 


4,817 


4.266 


9,083 


277 


9,561 







NUMBER OF DEATHS AND DEATH RATE PER 1,000 AMONG RESIDENTS, BY 

NATIONALITIES. 



Nationality. 


Male. 


Annual 
death 

rate per 
1.000. 


Female, 


Annual 
death 

rate per 
1.000. 


Total. 


Annual 

death 

rate per 

1.000. 


AmeHcans _ . _ 


40 
6,127 
42 
16 
337 
21 


11.16 
48.73 
17.39 
15. 57 
22.12 
14.92 


16 

5,713 

13 

8 

26 
10 


8.46 
51.37 

6.52 
16.70 
18.28 
18.08 


56 
11,840 
55 
24 
363 
31 


10.23 


Filipinos 


49.97 


Spaniards 


12.48 


Other Europeans 


15.93 


Chinese _ 


21.79 


All others . _ _ 


15.81 






Total .- _ — ___ 


6,583 


44.06 


5,786 


49.22 


12,369 


46.33 







248 

A CLASSIFIED REPORT OF ALL DEATHS OCCURRING IN MANILA, INCLUDING 

TRANSIENTS. 



Social condition. 



Married 1.792 

Divorced 2 

Widowed ; 462 

rle.. .- --. I 1,083 



Number. 
Male. Female. Total. 



Single 
Children . 
Condition not stated . 



4,519 

84 



Total I 7,942 



1,387 

1 

816 

362 

3,920 

17 



6.503 



3,179 
3 
1,278 
1,445 
8,439 
101 



1 14,445 



^ Of this total, there has been included 1 Chinese male, 3 males and 2 females, Filipinos, 
permanent residence unknown. 

Stillbirths 503 

Number of deaths with medical attendance 7,585 

Number of deaths without medical attendance 6,860 

DEATHS, BY AGES. 



Ages. 



Under 30 days 

30 days to under 1 year 

1 year to under 2 years. 

2 years to 4 years 

5 years to 9 years 

10 years to 14 years 

15 years to 19 years 

20 years to 29 years 

30 years to 39 y«ars 

40 years to 49 years 

50 years to 59 years 

60 years to 69 years 

70 years to 79 years 

80 years to 89 years 

90 years to 99 years 

100 years and over 

Age not stated 

Total.. -. 



Residents. 


Transients. 


Total. 










Male. 


Female. 


Male. 


Female. 




556 


338 


30 


18 


942 


1,135 


999 


270 


265 


2,669 


808 


764 


58 


46 


1.676 


969 


902 


66 


54 


1,991 


455 


401 


34 


36 


926 


120 


79 


17 


17 


233 


243 


179 


72 


23 


517 


537 


504 


257 


% 


1,394 


396 


412 


19f) 


79 


1.077 


418 


260 


155 


34 


867 


348 


251 


103 


13 


715 


241 


206 


57 


17 


521 


180 


189 


18 


6 


393 


101 


169 


8 


6 


284 


62 


119 


1 


2 


184 


5 


10 






15 


9 


4 


19 


3 


35 


6,583 


5,786 


1,355 


715 


14,489 



DEATHS AND RATE PER 1,000, BY DISTRICTS, INCLUDING TRANSIENTS. 



Health districts. 



Deaths. 



-I- 



No. 1, Intramuros 

No. 2, Mesic 

No. 4, Sampaloc--. 

No. 5, Tondo 

No. 6, Paco 

Total 



2.146 
2,620 
2,055 
6.306 
1.318 



Annual 
death 

rate per 
1, 000. 

65.09 
28.27 
45.78 
86.58 
45.26 



53.01 



* Of this total, there has been included 3 males and 2 females, Filipinos ; and 1 Chinese 
male, permanent residence unknown. 



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279 



DEATHS, BY OCCUPATIONS. 



Occupation. 



Professional: 

Architects, artists, teachers of art, etc 

Clergymen, priest, nuns, etc 

Engineers and surveyors 

Journalists 

Lawyers 

Musicians and teachers of music 

Nurses and midwives 

Physicians and surgeons 

Teachers (schools) 

Others of this class 

Clerical and official: 

Bookkeepers, clerks and copyists . 

Bankers, brokers and officials of companies 

Collectors, auctioneers and agents 

Stenographers and typewriters 

Telegraph and telephone operators , 

Others of this class 

Mercantile and trading: 

Apothecaries, pharmacists, etc 

Commercial travellers 

Merchants and dealers 

Hucksters and peddlers 

Shopkeepers--- 

Others of this class 

Public entertainment: 

Hotel and boarding house keepers 

Saloon keepers, liquor dealers, bartenders, and restaurants keepers . 

Personal service, police and military: 

Barbers and hairdressers 

Janitors and sextons . 

Policemen, watchmen, and detectives - 

Soldiers, sailors, and marines 

Other of this class 

Laboring and servants: 

Laborers (not agricultural) 

Launderers 

Servants 

Manufacturing and mechanical industry: 

Artificial flower and paper box makers 

Bakers and confectioners 

Blacksmiths 

Boot, shoe and slipper makers 

Brewers, distillers and rectifiers 

Butchers 

Cabinet makers and upholsterers 

Carpenters and joiners 

Cigar makers, and tobacco workers 

Clock and watch repairers, jewelers, etc 

Compositors, printers, etc 

Coopers 

Embroiderers (gold, silk, etc) 

Engineers and firemen (not locomotive) 

Glass blowers and glass workers 

Hat and capmakers 

Iron and steel workers 

Leather workers 

Machinists 

Marble and stone cutters 

Masons (brick and storte) 

Mill and factory operative (textiles) 

Miller (flour and grist) 

Milliners 

Painters, glaziers, and varnishers 

Plumber, gas and steam fitters 

Tailors, dressmakers and seamsters 

Tinners and tinware makers 

Others of this class 

Agriculture, transportation, and other outdoor: 

Boatmen and canalmen 

Draymen, drivers and teamsters.. 

Farmers, planters, and farm laborers 

Gardeners, florists, nurserymen, etc.... ^ 

Livery stable keepers and hostlers 

Lumbermen and raftsmen... 

Miners and quarrymen 1.. 

Sailors, pilots, fishermen, and oystermen ._ 

Steam railroad employees . ^ 

Stock raisers, herders and drovers ^.^ 

Others of this class _ ^^ 

All other occupations ...*-_ 



Total 

Grand toUJ 



Number. 

Male. Female. 

I 

2 
17 

6 

3 

6 
24 



3 
9 

16 I 

212 ; 

4 
8 



2 
31 



4 

153 

5 

20 

24 



32 
23 
27 
81 
11 

963 

19 

136 



9 
9 
23 
1 
2 



135 
84 
17 
15 
1 
4 
17 



4 
40 

7 
24 



49 
12 
21 

15 
113 
240 

11 



141 

14 

1 

18 

861 

3,277 



4,516 



280 

INFANT MORTALITY. 



Causes of death. 


Under 24 hours. 


So 
U 




li 

00 


Oi 
C 








1 


i' 

1 
43 

1 




Angiocholitis 










Arthritis, suppurative 












Athrepsia .- -- - 








1 




(Parrot's disease) 










Asphyxia, noonatorum 


11 




1 






Atrophic -- 




5 

1 

644 




Atelectasis of the lungs __ 


1 




2 


3 

1 




Bronchitis: 

Acute - 




Capillary. ._ __. 








16 


Chronic .- -. 










65 

7 

189 

12 




Grippal _ _ 
















1 




3 




Grippal- - 






Burns -- 










1 


Cardiac dilatation with hypertrophy of right side . 










1 
,1 
2 
2 

140 




Cholelithiasis 




' 






Congenital asthma 










Congenital atelectasis of the lungs __ 




1 

36 








Congenital debility . 


201 


io 


255 
1 




Congenitai malformation of skull 




Consumption __ _ ___. 






i i 


Congenital malformation 










1 1 


Diphtheria 










1 ! 


Diarrhoea and enteritis 








- ... 


31 i 


Dyspepsia.- 










1 


Gastrointestinal 











5 1 


Dysentery .- .i 






55 ' 


Eczema --I 








2 : 


Empyema, pleural - 








1 1 


Endocarditis (infectious) i . 








1 ; 


Enteritis, acute i . .- 






1 


96 


Entercoolitis - - _. .. ' 






12 
14 
2 
1 
3 
1 
1 
140 
4 




Erysipelas .■ - - 








Fibrinous pleurisy - '< 










Fibrino-purulent pleurisy and chronic pericarditis- 
Furunculosis 






















Fever of unknown character - ' 










Gastritis acute .. _ . _ . . - 












Gastroenteritis 








1 
1 




Grippe .. 


1 








Haomorrhage: 

Internal traumatism -- . 









1 1 


Intestinal 








1 
1 


.- 

1 
1 
1 
1 
1 
2 




Nasal _. - _. 










Nowborn .- 










Umbilical - 


1 






4 




Haomorrhagic, acute and follicular colitis 








Haomophilia- __ _ 


1 










Heart, dilation -_- 










Hypertropy 












Hydrocephalus .-_ _ _ 












Haemorrhage, naonatorum - -. 








1 




Lungs and kidneys 




1 






Infantile diarrhcea - . .-. _ .- 








1 

573 

159 

20 

12 

'3" 

2 
1 

1 

1 

1 

187 

92 
10 
1 

12 
3 
2 
1 




Beriberi . 








24 
52 
4 




Convulsions 


3 


1 






Icterus - 




Ileocolitis __ __ 










Imperforated anus _ 








2 




Indigestion, gastric __ 










Gastrointestinal, chronic . _. _ . 












Inanition ._- 












Intestinal obstruction 












Lack of care _. . . . _. 












Malarial fever 












Malnutrition 




1 




1 
3 




Meningitis: 

Acute .- ■_ _ -____. 






Cerebral 










Suppurative 












Tuberculous __ 












Measles 












MyocarditiB, acute 




1 








Mastoid abscess 











281 

INFANT MORTALITY— Continued. 



Causes of death. 



Nephritis: 

Acute 

Chronic 

Oedema of the glotis 

Omphalitis, acute peritonitis 

Omphalorrhagia 

Organic heart diseases (congenital) 



Pleurisy . 

Petechial haemorrhagic of viscera 

Pneumonia, lobar 

Premature birth 

Postmortem decomposition 

Persistance of foramen Botallo 

Pleuropneumonia 

Pulmonary congestion — 

Purulent infection and septichsemia . 

Rickets 

Sclerema (oedematous) 

Subdural left parietal 

Scrofula 






3S 

SCO 



Scurvy _ 

Smallpox - 

Sy phi lis 

Smallpox, probable ._ 

Tetanus, unbilical 

Tuberculosis: 

Intestinal 

Peribronchial 

Pulmonary 

Typhoid fever 

Undetermined cause . 
Whooping cough 



Total . 



7 
2 

" l" 
2 
2 
195 
1 
1 
3 

2 

1 
1 
1 
2 
9 



428 i 2,884 



22 
18 

1 
2 
1 
3 
2 
2 
6 

25 
1 
3 
1 
1 
7 
2 
1 
1 
2 
2 
196 
1 
1 

61 

2 
1 
1 
1 
4 
9 



3,611 



COMPARATIVE MORTALITY FROM JANUARY, 1908, TO DECEMBER, 
1918, INCLUSIVE. 





1908 


1909 


1910 


1911 


Month. 


Number 

of 
deaths. 


Annual 

death 

rate per 

1,000. 


Number 

of 
deaths. 


Annual 

death 

rate per 

1,000. 


Number 

of 
deaths. 


Annual 

death 

rate per 

1,000. 


Number 

of 
deaths. 


Annual 

death 

rate per 

1,000. 




1,117 
733 
720 
626 
633 
678 
977 
1,148 
1,362 
991 
837 
824 


a 58. 87 
a 41. 29 
a 37. 94 
a. 34. 09 
•>33.36 
a 36. 92 
a 51. 49 
a 60. 50 
a 74. 17 
a 52. 23 
a 45. 58 
a 43. 42 


720 
616 
218 
550 
544 
552 
691 
679 
649 
700 
778 
839 


a 37. 94 
a 35. 94 
a 32. 57 
a 29. 95 
a 28. 67 
a 30. 06 
a 36. 41 
a 35. 78 
a35.34 
a 36. 89 
a 42. 37 
a 44. 22 


729 
638 
642 
594 
604 
646 
799 
731 
664 
705 
642 
635 


b36.64 
b 35. 50 
b32.26 
b30.66 
b30.35 
b33.55 
b40.l5 
b36.74 
b34.48 
b35.43 
b33.34 
b31.91 


653 
536 
574 
647 
609 
693 
830 
878 
741 
686 
782 
698 


b32.82 


February 


b29.82 


March 


b28.85 


April 


b28.41 


May 


b30.60 


June - - 


b35.99 


July 


b41.71 


August 


b44.13 


September 


b 38. 48 


October 


b34.48 


November 


b40.61 


December 


b35.08 






Total... 


10, 646 


a 47. 62 


7,936 


a 35, 50 


8,029 


b34.25 


8,227 


b 36. 09 



"Death rate computed on population of 223,542 (Health census, 1907). 
''Death rate computed on population of 234,409 (Health census, 1910). 



282 

COMPARATIVE MORTALITY FROM JANUARY, 1908, TO DECEMBER, 
1918, INCLUSIVE— Continued. 





10 

Number 

of 
deaths. 

698 
611 
732 
671 
701 
605 
689 
705 
661 
633 
573 
540 


13 

Annual 
death 

rate per 
1,000. 

b35.08 
b 32. 82 
b36.79 
b34.85 
b35.23 
b3L42 
b34.63 
b 35. 43 
b 34. 33 
b31.81 
b29.76 
b 27. 14 


19 


1» 


1914 


19 

Number 

of 
deaths. 

678 
546 
570 
551 
557 
557 
605 
602 
542 
553 
482 
578 


15 


Month. 


Number 

of 
deaths. 

502 
445 
451 
442 
504 
442 
410 
439 
529 
550 
590 
600 


Annual 

death 

rate per 

1.000. 


Number 

of 
deaths. 

570 
499 
462 
464 
430 
387 
540 
. 581 
693 
624 
651 
686 


Annual 

death 

rate per 

1,000. 


Annual 

death 

rate per 

1,000. 




b25.23 
b24.76 
b22.66 
b22.95 
b25.33 
b22.95 
C19.49 
c 20. 87 
C25.99 
C26.15 
c 28. 99 
c28.53 


d25.15 
d24.38 
d20.39 
d21. 16 
d 18. 97 
d 17. 65 
d23.83 
d25.64 
d31.60 
d27.54 
d29.69 
d30.67 


d29.72 


February 

March 

April 

May 

June 

July 


d26.63 
d25.15 
d25.13 
d24 58 
d 25. 40 
d26.70 


Augrust 

September 

October 


d26.57 
d24.71 
d24.40 
d21.98 


December 


d25.51 


Total 


7.819 
nth. 


b33.35 


5,904 
19 

Number 
of deaths. 

634 
559 
593 
567 
548 
513 
573 
717 
827 
351 
494 
589 


c 24. 48 

16 

Annual 
death 

rate per 
1,000. 

d27.96 
d26.37 
d26.17 
d25.85 
d24. 18 
d23.39 
d23.29 
d31.64 
d37.71 
d25.31 
d22.53 
d25.99 


6,587 
19 

Number 
of deaths. 

485 
469 
539 
500 
545 
500 
555 
615 
548 
598 
639 
689 


d24.67 


6,820 



19 

Number 
of deaths. 

713 

685 

878 

854 

1,125 

1,242 

1,083 

957 

917 

1.121 

1,867 

817 


d25.54 


Mo 


17 

Annual 

death 

rate per 

1,000. 

d21.40 
d22.91 
d23.78 
d22.80 
d24.05 
d22.60 
d24.49 
d27.14 
d24.99 
d26.39 
d29.14 
d30.41 


18 

Annual 
death 

rate per 
1,000. 

d31.46 




d33.47 




d38.75 


April -- 


d43.51 


May 


d50.09 




d56.64 


July 


d47.80 




d42.23 




d41.82 


October - 


d49.47 


November . 






d85.15 


December 






d36.05 


Total 


7,165 


d26.84 


6,682 


d25.03 


12. 369 


d46.33 



MORTALITY COMPARED WITH SAME PERIOD OF PREVIOUS YEARS. 



1908 2,570 

1909 1,954 

1910 2,009 

1911 1,763 

1912 2,041 

1913 1,398 

1914 1.531 

1915 1,793 

1916 — 1,786 

1917 i 1.493 

1918 i 2,276 



First quarter. Second quarter. Third quarter. Fourth quarter. 



Num- 
ber of 
deaths. 



Annual 
death 

rate per 
1,000. 

46.14 
35.47 
34.78 
30.52 
34.94 
24.20 
23.27 
27.25 
26. 85 
22.69 
34.60 



Num- 
ber of 
deaths. 



1.937 
1,646 
1,844 
1.849 
1.977 
1,388 
1,281 
1,665 
1,628 
1,545 
3.331 



Annual 

death 

rate per 

1,000. 

34.77 
29.55 
31.57 
31.65 
33. 85 
23.76 
19.26 
25.03 
24.47 
23.23 
50.08 



Num- 
ber of 
deaths. 



3,487 
2,019 
2,194 
2,449 
2,055 
1,378 
1,814 
1,749 
2,117 
1,718 
2.957 



Annual 
death 

rate per 
1.000. 



61.92 
35.85 
37.15 
41 47 
34.80 
22.08 
26.97 
26.01 
31.48 
25.55 
43.97 



.1 



Total. 



Num- 
ber of 
deaths. 



Annual 
death 

rate per 
1.000. 



2,652 
2,317 
1,982 
2,166 
1.746 
1.740 
1,961 
1,613 
1.634 
1.926 
3.805 



47.09 
41.14 
33.56 
36.68 
29.57 
27.88 
29.16 
23.98 
24.30 
28.64 
56.58 



Num- 
ber of 
deaths. 



10, 646 
7,936 
8.029 
8.227 
7.819 
5.904 
6,587 
6.820 
7,165 
6,682 

12.369 



Annual 
death 

rate per 
1,000. 



b Death rate computed on population of 234,409 (Health census, 1910) 

« Death rate computed on estimated population 247,756. 

d Death rate computed on population of 266,943 (Health census, 1914). 



47.62 
35.50 
34.25 
35.09 
33.35 
24.48 
24.67 
25.54 
26.84 
25.03 
46.33 



283 



CHOLERA AND PLAGUE, CITY OF MANILA. 

Cholera. 



Nationality. 



American - 
Filipinos __ 
Spaniards . 



Other Europeans _ 
Chinese 

All others 



Total 



Health districts 

No. l.Intramuros. 

No. 2, Meisic 

No. 4, vSampaloc ._ 

No. 5, Tondo 

No. 6. Paco 



i 



Plague. 



Cases. 
Male. Female. 



1 
115 



1 ' 

64 I 



Deaths. Cases. 

Male. Female. I Male. Female. 



1 i 
78 



Deaths. 
Male. IFemale. 



,- I'- 



ll? I 



65 ! 



District and ajare. 



Total 

ARes: 

Under 1 year 

1 year to 9 year 

10 years to 19 years, 
20 years to 29 years- 
30 years to 39 years . 
40 years to 49 years . 
50 years and over.. - 
Unknown 



Total . 



Cholera. 



Cases. Deaths. Cases. (Deaths, 



Plague. 

" !r 



13 i 

23 

11 

55 

21 

123 



51 1 


44 


22 i 


10 


44 


23 


27 ! 


18 


18 1 


11 


20 : 


17 



123 



Number of cases found alive, cholera 128 ; plague, 0. 
Number of cases found dead, cholera, 54 ; plague, 0. 



SMALLPOX, CITY OF MANILA. 

A total of 1,326 cases and 869 deaths of smallpox occurred during the 
period covered by this report. 

VARIOLOID, CITY OF MANILA. 

A total of 521 cases and 11 deaths of varioloid occurred during the period 
covered by this report. 

VARICELLA, CITY OF MANILA. 

A total of 315 cases of varicella occurred during the period covered by 
this report. 



284 



TUBERCULOSIS CASES REPORTED IN THE CITY OF MANILA DURING THE FISCAL 

YEAR 1918. 

[Closed March 16, 1919.] 













Health districts- 










Nationality. 


No. 1. 


No. 2. 


No. 4. 


No. 5. 


No. 6. 


Total. 


Americans 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 


Male. 


Fe- 
male. 




Male. 


Fe- 
male. 


. 








I 


Filipinos 


31 2fi 


224 
1 
1 


183 


96 


65 


190 


159 


91 


65 


1 13( 


Spaniards 






1 


Other Europeans 




















1 


Chinese 






31 


1 


1 




1 


1 




35 

1 


All others 






1 




















92 




Total 


31 


26 


257 


184 


97 


65 


192 


159 


65 


1 168 







Also reported 115 males and 73 females, provincial cases ; i 
residence unknown. 



males and 5 females, permanent 



RAT CAMPAGIN OPERATIONS. 

Number of spring traps set 331,49^ 

Number of rats caught with spring traps .'. 70,980 

Number of wire traps set _ _..„ 341 

Number of rats caught with wire traps 31 

Number of rats caught by dogs 6 

Number and kind of baits set (coconuts) _ 596,339 

Number of poison portions placed 665,706 

Number of rats found poisoned. 3,730 

Number of rats killed by clubs and other weapons 11,780 

Number of rats found dead from other causes 3,366 

Total number of rats otherwise caught or killed 89,893 

Total number of rats sent to Laboratory for examination 89,893 

Rats found positive for plague 

MOSQUITO CAMPAIGN OPERATIONS. 

Houses inspected during the year 136,996 

Houses where breeding places found 11,376 

Breeding places found in houses 12,937 

Vessels ordered emptied or removed 11,113 

Drains ordered cleaned 6,660 

Lineal feet of drains ordered dug 1,985 

Breeding places oiled on private premises 112,717 

Breeding places oiled on public premises 89,972 

Water receptacles overturned 12,112 

Square feet of grass ordered cut 376i 

Cans of oil used. 2,419i 

Sanitary orders issued _ 1,828 

Insanitary conditions reported to health stations 145 

Number of complaints attended 524 

Number of fines : 

P2 each 2 

3 each _ 22 

5 each 83 

8 each „ 1 

10 each 9 

15 each _ 1 

20 each _ 2 

70 each 1 

75 each _..„ 1 

Fly inspector's report: 

Stables inspected during the year i. 12,489 

Stables ordered cleaned _ „ 8,732 

Stables cleaned 7,594 

Market inspections made _ _ 182 

Mosquito brigade : 

Number of disinfections made of public midden sheds 15,032 

Number of liters of disinfectans used.™ 1,331,700 

Number of bayones of lime used, _ „ 305i 

SANITARY ORDERS. 

Rat-f roofing : 

Sanitary orders remaining December 3, 1917 35 

Sanitary orders issued _ 3 

Sanitary orders completed „......_ _ 23 

Sanitary orders pending action by city fiscal 6 

Sanitary orders awaiting action 9 

Cleaning : 

Orders remaining December 81, 1917 

Orders issued 3,577 

Orders completed - 3,670 

Orders awaiting action 7 



285 



w 



pq 

P 
W 
Q 
;zi 

H 
H 

o 
o 

p 
» 
p 

o 

P 
<J 

M 
o 



o 

H 

o 






Pr, CU 



IV, cS 

^S i 



1 . 6 

I [v, OS 

I ^a 



fa 2 



fe * 



(M OJ as (N Mr 



10 -^ 






C- O «D Oi r}< 1-1 
(M rH O to CO 





2g 

Or-t 


eg 


■CO 




b 




rH 







rH 1-1 Ot 



H C 
5.2 



US Tf (N 






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1T3 "5 O 
2 5S'lJc^.§ -^ 



w LL 00 m O • <>u 
C(NrJ<)C!U3'OtO\r3EH 

iziiz; ;? iz; Q 



286 

CITY MORGUE REPORT. 



Disposition. 



! Num- 
ber of 
bodies. 



Disposition. 



I Num- 
I ber of 
i bodies. 



Remaining from last year 52 

Received .__ i 1,715 

Total 1,767 i! 



Buried by: 
City ..-. 
Family . 



731 

858 



Transferred to: 

Army morgue 10 

Government museum 6 

Provinces 81 

Remaining at end of the year '. 81 

Total i 1,767 



DISPOSITION OF DEAD BODIES. 



Disposition. 


Num- 
ber. 

• 

595 
5,248 

500 
6,499 

214 

• 46 

78 

1,149 

117 

[SINTE] 

Num- 
ber. 

8 
20 
49 
17 

8 

17 

233 


Disposition. 

j Remaining in— 

i Army Morgue . . 


Num- 
ber. 


Buried at cemetery of— 

Balicbalic . _ 


4 


Binondo 

Chinese .. ._ _ 


City Morgue 

Private Morgues ._ ._ 


78 
6 


Norte --- - .- -- 


Mary Johnston Hospital (footus) .__ 

1 Mary Chiles Hospital (footus) 

Philippine Dental College - 


1 


Pandacan: 

Filipino church- 


1 
2 


Roman Catholic . _ _ ._ . _ 


Santo Tomas University 

Santo Tomas Museum (footus) 

Shipped to the United States 

Transferred to— 

Government Museum (stillbirths).-. 
Provinces.- . 


44 


Santa Ana 


2 


Singalong ._ 


2 


Otherwise disposed of— 

Cremated 


41 
558 




Total 

RMENTS. 

Cemetery. 


15, 180 


D] 




Cemetery. 


Num- 
ber. 


Balicbalic 


Pandacan 


3 


Binondo 


Santa Ana 

Santa Cruz 


3 


Chinese _. . _ .- _ 


39 


Loma.- 


Singalong 


1 


Malate 

Norte _ . 


Tondo 

Total 


14 


Paco 


412 









287 



GENERAL INSPECTIONS OF HOUSES, PREMISES. VAULTS, ETC., WITH IMPROVE- 
MENTS ORDERED, WHITEWASHED, CLEANED, ETC., BY MEDICAL INSPECTORS, 
SANITARY INSPECTORS, AND ASSISTANT SANITARY INSPECTORS. 



11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 
28. 
29. 

to. 

$1. 
12. 
S3. 
S4. 

15. 
S6. 
17. 
S8. 
S9. 



Inspections of houses by sanitary inspectojs 

Reinspections of houses for verification of work ordered 

Inspection of houses by assistant sanitary inspectors and sanitary policemen 

Reinspection of houses by assistant sanitary inspectors and sanitary policemen- 
Houses ordered cleaned (written) 

Houses ordered cleaned (verbal) 

Houses cleaned 

Houses ordered whitewashed and painted 

Houses whitewashed and painted 

Number of houses recommended condemned and removed 

Number of houses condemned and removed 

Numl)er of localities where "sciuatters" are located 

Number of samples of water, foods, etc., sent to lalmratory 

Number of reports for same 

Number of fire-pluj?s opened or closed for sanitary purposes 

Number of hydrants recommended reopened 

Number of houses where garbaj?e has not been removed for two days 

Number of persons reported sick to municipal physicians 

Cesspools and vaults ordered cleaned 

Cesspools cleaned 

Yards ordered cleaned 

Yards cleaned 

Yards ordered repaired (repaved, etc.) 

Yards repaired 

Number of choitra cases reported by sanitary insi»ectors 

Number of cholera cases found *'alive" 

Number of cholera cases found "dead" 

Number of orders issued durinj? the quarter 

Number of orders complied with during the quarter 

NumV)er of orders awaiting action 

Number of orders pending in court 

Average number of food tiendas in the districts 

Number of persons convicted for violation of prohibition orders 

Average number of regular inspectors on duty 

Average number of regular emergency inspectors on duty 

Number of lepers sent to San Lazaro Hospital 

Number of plague cases reported 

Number of smallpox cases reported „ 



22,679 

6,984 

189,311 

31.086 

4.673 

19,182 

21,716 

669 

664 

17 





35.735 

25.489 

17 



118 

16.677 

4 

107 

12.874 

12,624 





71 

286 

42 

5.576 

4,992 

257 

151 

2,875 

397 

72 




1,516 



REPORTS OF DISINFECTIONS. 



Causes for disinfections. 



Anthrax 

Bubonic 

Bubonic plague contacts 

General for bubonic plague 

General for bubonic plague suspected. 

Carbuncle 

Chickenpox 

Cholera . 



Cholera carrier 

Cholera contacts 

Cholera observation 

Cholera, suspected 

Cholera, suspected (contacts) 

Cholera, suspected and varioloid _ . 

Cholera vibrio carrier 

General for cholera, suspected 

General for cholera vibrio carrier . 
Dengue 



Disin- 
fec- 
tions. 



Diarrhea 

Diarrhea enteritis 

Diphtheria 

Diphtheria carrier 

Diphtheria, suspected 

General for diphtheria 

General for diphtheria, suspected 

Dysentery 

Dysentery acute 

Dysentery contacts 

Dysentery carrier 

Dysentery and cholera vibrio carrier 

Dysentery chronic 

Dyeentery and leprosy 

General for dysentery 

General for dysentery acute 

General for dysentery carrier 

Enteritis 

Gaatro enteritis observation for cholera. - 



Con- 
tacts. 



2 

1 
2 

1 

?! 

2 i 
1.310 ! 

6 i 
24 I 

4 I 
557 
17 

1 

52 

242 

205 

2 

5 

6 
45 

2 
15 
58 
25 
996 
15 

6 

8 

3 

1 

1 

613 

54 

1 

2 

4 





6 

6 

14 



3 

5 

23.208 

36 

169 

36 

5,819 

42 

15 

803 

1,775 

1,118 



12 

28 

204 

5 

60 

131 

29 

5,146 

73 

6 

27 

45 

4 

6 

3.050 

287 





288 



REPORTS OF DISINFECTIONS— Continued. 



Causes for disinfections. 



Grippe 

Gonorrhoea 

Hookworm amoabae 

Human remins ... 

Insanitary 

Insanitary (fleas) 

Insanitary (flies) 

Insanitary and vermin . 

General for insanitary . 

Leprosy . 



Leprosy (contacts) 

Leprosy, suspected 

Leprosy, suspected (contacts) 
Leprosy and vibrio carrier 

Malaria fever 

Measles- 



Meningitis 

Mosquitoes and insanitary . 
Mumps - 



Observation for cholera 

Observation for plague 

Ophthalmia gonorrheic 

Paratyphoid 

Perutyssis 

Pheumonia 

Pheumonia grippal 

Pheumonia plague 

Pheumonia plague contacts 

Pulmonary tuberculosis 

Pulmonary tuberculosis suspected . 

Redisinfection for dysentery 

Smallpox . 



Smallpox contacts 

Smallpox, suspected 

Smallpox and 1 measles 

General for smallpox 

Sudden death 

Tetanus 

Tuberculosis 

Typhoid fever 

Typhoid fever contacts 

Typhoid fever, suspected 

General for typhoid fever 

General for typhoid fever suspected . 

Undetermined 

Varicella 

Varicella contacts 

Varioloid 

Varioloid contacts 

Varioloid, suspected 

Vermins 



Total 8,192 

i 



Disin- 
fec- 
tions. 


Con- 
tacts. 


62 


26 


1 


6 


1 





182 





476 


397 


3 





33 


1 


1 





2 





49 


133 


3 


7 


20 


41 


1 





1 





1 





38 


120 


1 





2 





32 


30 


4 


7 


1 


3 


1 


3 


1 


4 


1 


4 


2 


6 


1 





2 


47 


3 


105 


198 


357 


1 





6 


21 


1,181 


4,900 


28 


175 


7 


29 


1 


12 


14 


90 


1 





36 


93 


78 


33 


350 


2,021 


4 


12 


12 


77 


292 


1,432 


48 


72 


6 


11 


380 


1.821 


2 


12 


300 


1,140 


16 


86 


3 


2 


12 





8,192 


55, 597 



REPORT OF ACTION TAKEN ON APPLICATIONS FOR LICENSES. 

Approved 8,675 

Disapproved 426 

Total acted upon 9,100 



289 

CHOLERA IN THE PROVINCES. 

[Closed March 16, 1919.] 



Towns and provinces. 



Albay: 
Albay - 



Antique: 

San Jose . 

Bataan: 

Abucay .. 
Balanga.- 

Orion 

Pillar .-_ 
Samal 



Total.. 



Batan{?as: 
Batangas . 

Bauan 

Bolbok-_-. 

Ibaan 

Lipa 

Lobo 

Mabini 

Rosario 

San Jos6 -. 

Total -..- 



Bohol: 

Albuquerque. 
Anda.. 



Antequera . 
Baclayon.-- 
Balilijan .-. 

Calape 

Canrtijay _.. 

Corella 

Cortes - 



Dimiao 

Duero 

Guindulman . 

Inabanga 

Jetafe 

Loay 

Lobero 

Loboc 

Loon -. 

Mabini 

Manbojoc 

Panglao 



Cases. 'Deaths 



170 

217 

52 

1 

12 
7 
4 

27 
7 

497 



140 

146 

39 

1 

8 

6 

2 

30 



Sevilla . 

Sierra Bullones . 

Sikatuna 

Tagbilaran 

Talibon. 

Tubigon.- _. 

Ubay 

Valencia 



Total - 



Rulacan: 

Bigaa .-_ 

Bocaue 

Calumpit 

Hagonoy 

Malolos 

Marilao 

Meycauayan . 

Obando 

Paombong ._. 

Polo 

Quinua 

Santa Maria . 



Total 

168426- 



7 


6 


48 


22 


29 


26 


30 


29 


23 


18 


125 


114 


28 


18 


13 


13 


17 


14 


23 


20 


2 


1 


53 


37 


95 


74 


16 


16 


44 


33 


1 


1 


55 


40 


344 


230 


40 


27 


9 


5 


29 


20 


3 


3 


21 


12 


9 


7 


10 


8 


18 


16 


153 


127 


13 


10 


124 


63 



1,010 



Mor- 
tality. 



Perct. 
100.00 



100.00 



75.45 



73.08 



290 



CHOLERA IN THE PROVINCES— Continued. 



Towns and provinces. 


Cases. 

1 

8 
35 
45 

8 

3 
3 

36 
2 
11 
48 
30 
2 
3 

253 

74 
17 
33 
41 

1 

11 
37 

9 

2 
27 

2 

38 
53 

345 


Deaths. 


Mor 
talit 


Capiz: 

Altavas 


1 
5 

30 
35 

7 
4 
1 
6 

5~ 

.. 

3 

33 
1 
8 
43 
25 
1 
3 

214 

54 

15 

25 

24 

1 

5 

26 

6 

2 

18 

2 

35 

37 

250 


Perc 


Banga. . 




Calivo - - 




Capiz -- 




Dao .- _ .- . 




Dumalag 




Dumarao .. _.. 




Itiisan - - - - _ - 




Jamindan . .. 




Lezo _ -- _ _- .- - -- 




Libacao ._ 

Malinao ._. . _ .. _. _ __ 




MambuBao - .. __ __ _. ... _ . 




New Washington - 




Panay -. .. . _. ... .. ._ ._ . 




Panitan - -_--___.- 




Pilar 




Pontevedra . . ._._ . 




Sigma _ - - _ 




Tapaz .. 




Total 

Cavite: 

Bacoor . --- 


84. 


Cavite 




Dasmarinas -_ 




Imus _ _ __ . - . 




Indang.. _. 

Kauit _. -- . 




Malabon 




Maragondong ._ ._ . __ 




Mendez Nunez . ._ > _ 




Naic 




Noveleta . .. . 




Rcsario. ... _____ 




Tanza 

Total - _ . 


72 






Cebu: 

Alcoy 

Alegria 

Aloguinsan ..... 


4 
12 

1 

11 
12 
36 
91 
14 

2 

86 
18 
18 

9 
17 
11 
12 
17 

2 

4 
56 

3 

2 

3 
114 

3 
116 
47 

1 


2 

8 
2 
7 
9 

23 

58 
6 
1 

62 
8 
8 
6 
6 
, 9 

10 
8 
1 
3 

29 
2 
2 
3 

62 
1 

59 

23 
1 




Argao 




Badian 




Balamban . _ _ . 




Bantayan . _ __ 




Barili . 




Bogo _ _ 




Cebu 




Cordoba 




Dalaguete ._ _ 




Danao _. _ . ._ 




Dumanjug 




Ginatilan __ 




Malabuyoc . . 




Mandaue 




Minglanilla __ .. . 




Opon - _ ._ . . , _ 




Pinamungajan _ 




Samboan _ . 




Santander _ _ _ . _ . _ . 




San Fernando -- 




San Francisco . 




San Rennigio __ _ _ _ _ _ , 




Santa F6 . . _ 




Talisay ._. 




Toledo 








Total - 


722 


419 


58 






IIocos Sur: 

Candon . 


23 


10 


43 







291 



Hollo: 



Balasan 

Banate 

Barotac Nuevo 


16 

! 9 

; 12 


Barotac Viejo 

Buenavista 

Cabatuan 

Dingle 


9 

3 

i 1 

5 


Duenas 

Guimbal ... 

Iloilo 


' 14 

64 

56 


Janiuay 


i 19 


Jaro 

Jordan 


' 18 

' 2 


Lambunao 

Oton 

Passi 

Pototan 


: 8 

: 13 

; 2 

.. ._ . ! 21 


Santa Barbara 

Tigbauan 

Total 

Laguna: 

Cabuyao . . ._ 


! 2 

- i 31 

305 


Calauan ,.._ 

Nagcarlan ._._ .. _.. 


;-:;■; ; i } 


Pila 


i 4 


San Pablo 

Santa Cruz 


: i 8 

; 5 



CHOLERA IN THE PROVINCES— Continued. 

Towns and provinces. ; Cases. Deaths 



205 




Department of Mindanao and Sulu 
Agusan: 
Bunauan 
Butuan 
Cabadbaran 
Gibung 
Simolao 
Talacogon 
Umayan 
Wawaojot 



Lanao: 
Iligan 
Kalumbugan 
Kapatagan 
Lanao 

Total 



Mor- 
tality. 



Per rt. 



67.21 



18 I 94.73 



63.26 



47.82 



292 



CHOLERA IN THE PROVINCES— Continued. 



Towns and provinces. 



Misamis: 

Aloran 

Balianj^ao _. 
Balingrasa?- 
Cagayan _._ 

Ginguog 

Initao - 

Jimenez 

Mambajao . 

Misamis 

Oroquieta .. 
Plaridel .— 

Tagoloan 

Tall say an ,. 



Total . 



Surig-ao: 

Gantilan .. 

Dapa 

Gigaquit .. 
Hinatuan . 

Lianga 

Placer 

Surigao ... 



Total- 



Zamboanga: 

Ganelar 

Dapitan ... 

Dipolog 

Labangan 

Margosatubig. 

Mercedes 

Santa Maria... 
Zamboanga 



Total . 



ses. 


Deaths'. 


4 


2 


9 


5 


10 


2 


139 


80 


14 


7 


26 


16 


54 


36 


4 


3 


349 


218 


28 


13 


50 


32 


172 


75 


2 


2 


861 


491 





Mindoro: 

Calapan _ 


9 
1 


15 




Lubang ._ . 








Total 


10 


15 










Mountain: 

Tagudin .. 




1 










Occidental Negros: 

Cadiz '., 


37 
96 
10 
4 

147 


24 
53 

8 
4 

89 




Escalante ._ 




Sagay __ _ _ . 




San Carlos . . . _> . 




Total.- 


60.54 




1 




Oriental Negros: 
Ayuquitan 


4 
21 

8 
23 

8 
35 
19 

1 

15 
68 

6 
17 
19 

6 

250 


3 
10 

7 
16 

5 
23 
11 

-- 

33 

1 

6 
12 

3 




Bais 




Dumaguete -- . 




Guijulngan __ 




Jimalalud 




Larena. . 




Lazi-- 




Luzuriaga ._ _ 




Manjuyod .. _ . 




Maria 




San Juan 




Siquijor 




Tanjay 




Tayasan _. ._ 




Total 


55.20 






Pampanga: 

Guagua _ 


1 
1 
5 


1 
1 
4 




Liubao.. _ 




Sexmoan. 








Total 


7 


6 


85.71 







293 



CHOLERA IN THE PROVINCES— Continued. 



Towns and provinces. 



Cases. Deaths. 



Mor- 
tality. 



Pangasinan: 

Alaminos 

Alcala 

Asingan 

Balincaguin 

Bani 

Bautista 

Bayambang 

Binalonan 

Binmaley 

Calasiao 

Dagupan 

Labrador 

Lingayen 

Malasiqui _ 

Manaoag 

Mangaldan 

Mapandan 

Pozorrubio 

Salasa 

San Carlos 

San Fabian 

San Jacinto 

San Manuel 

Santa Barbara. 

Sison 

Sual 

Urdaneta 

Villasis - -- 



62 


1 42 


1 


1 


3 


2 


1 


1 


6 


4 


7 


5 


10 


8 


11 


9 


49 


41 


7;j 


65 


115 


107 


7 


6 


95 


73 


7 


6 


53 


50 


127 


98 


22 


21 


17 


12 


27 


21 


3 


3 


64 


50 


82 


63 


1 


1 


25 


16 


11 


8 


12 


5 


7 


6 


19 


17 



Total 



Rizal: 

Caloocan . . . 
Las Pinas .. 

Makati 

Malabon 

Mariquina.- 

Navotas 

Paranaque . 

Pasay 

Pasig 



Total . 



?! 

2 

20 

1 
20 

1 

4 
10 



Samar: 

Calbayog . 



Sorsogon: 

Bulan 

Cataignan 

Dimasalang 

Gubat 

Masbate 

Milagros .. 

Mobo 

San Fernando- 



74 


42 


8 


1 


1 





9 

8 

124 



Total 



Tayabas: 

Candelaria . 

Dolores 

Sariaya 

Tiaong 

Unisan 



Total 



Union: 

Agoo 

Santo Tomas . 

Total 



8 
16 

4 
21 
12 


6 
10 

4 
12 

9 


61 


41 








8 
20 


8 
14 


28 


22 



294 



CHOLERA IN THE PROVINCES— Continued. 
SUMMARY, BY PROVINCES. 



Provinces. 



Cases. 



Albay _. 1 

Antique - 5 

Bataan \ 38 

Batanjsras 1 497 

Bohol ! 1,382 



Bulacan. 

Capiz 

Cavite 

Cebu 

IlocosSur - 

Iloilo 

Laguna . 

Leyte 

Department of Mindanao and Sulu: 

Ajarusan 

Da vao 

Lanao 

Misamis 

Suri^ao 

Zamboanga 

Mindoro 

Mountain . 



77 
253 
345 
722 

23 
305 

19 
196 

112 
12 
46 
861 
497 
107 
10 



Occidental NegroB 
Oriental Negros ..- 

Pampanga 

Pangasinan 

Rizal 

Samar 

Sorsogon 

Tay abas 

Union 



80. 80 
56. 75 
12.50 
46. 32 
67.21 
78.57 

Grand total ; 7,231 j 4,943 68.35 



147 '. 
250 
7 
917 
74 
8 
231 
61 
28 





Morta- 




lity. 




Per ct. 


1 


100. 00 


5 


100.00 


32 


84.21 


375 


75.45 


1,010 


73.08 


52 


67.53 


214 


84.58 


250 


72. 46 


419 


58.03 


10 


43.47 


205 


67.21 


18 


94.73 


124 


63.26 


56 


50. 00 


10 


83. 33 


22 


47.82 


491 


57. 02 


354 


71.22 


92 


85. 98 


15 




1 




89 


60. 54 


138 


55. 20 


6 


85.71 



741 

42 

1 

107 
41 
22 



295 

REPORTS RECEIVED OF BLIND PERSONS LIVING IN THE VARIOUS PROVINCES 
OF THE PHILIPPINE ISLANDS. 





Race. 


Children. 1 


Sin J 

13 

10 

7 
66 
31 
27 
22 

2 
31 
83 
28 
25 
34 
24 
85 

1 

5 
12 
41 
46 
27 

2 
86 


de. 

4 
4 

58 
25 
18 
6 
4 
23 
74 
21 
15 
28 
24 
69 

3- 

17 
30 
42 
17 

■""46" 


Married. 


Wido 

13 

5 

..... 

13 
15 

4 

5 
11 
13 
11 

5 
16 

4 
16 

3 
13 
16 

4 

3 
12 

1 
11 

3 

"21" 

10 

5 

27 

14 

15 

6 

11 

3 

4 

8 

7 

7 

8 

1 

339 


wred. 

1 

& 

6 

1 
21 
13 
16 

4 
18 
15 
14 
16 
14 
37 
14 
15 

1 

3 
11 
27 
29 
14 

"'is' 
1 

8 
14 

1 
11 
14 

5 
26 
36 
17 

2 
10 

3 

2 
14 

8 
12 
14 

1 


To 

32 
10 

130 
82 
66 
35 
12 
69 

153 
51 
66 
89 
52 

154 
2 
11 
31 
93 

109 
53 
6 

172 
3 

87 
56 
6 

106 
85 
15 

176 

163 
77 
40 

108 
83 
29 
48 
76 
38 
33 
6 


tal. 1 

s ■ 
1 ! 

21 
7 

98 
47 
51 
13 
30 
48 

112 
47 
37 
88 
55 

109 
3 
8 
41 
80 
85 
1 41 

r"'93 

' 4 

42 

43 

i 3 

1 63 

i 51 

15 

98 

132 

1 61 

21 

57 

39 

1 7 

1 42 

43 

31 

28 

1 

1,895 


t 


Provinces. 
Abra 


13 


s 


17 
3 

43 
30 
21 

5 

4 
23 
46 
12 
30 
37 
17 
43 

1 

5 
14 
29 
41 
15 

1 
53 

2 

29 
18 

1 
21 
21 

3 
68 
57 
38 
18 
23 
16 
11 
22 
20 
13 
11 


i 

V 1 

fe 1 

i 

'}i 

11 ! 

1 j 

7 i 
10 I 
21 I 

5 ' 

8 : 
21 
13 ' 
24 1 

1 

2 
11 
14 
12 

8 

"23" 
3 

It 

1 
9 
10 
2 

24 

40 

15 

1 

13 
6 
1 

11 
8 
7 
4 


B 

c 
2 


58 


... do 




1 

8 
6 
5 
2 
1 

5 
..... 

4 

} 


17 


Albay 


do 


14 
8 
3 
4 
1 
4 

11 


228 


AmboB Camarines- 
Antique 


do 

_. do 


129 
117 


Bataan 


do 


48 




do 


42 


Batang'as 


. do 


117 


Bohol 


do 


265 




....do 


98 


Ca^ayan .. 


do 


6 
2 
7 
10 


103 




do 


177 


Cavite 


.__. do 


107 




do 


263 




do 


5 




_ do 




19 


I locos Norte 


do 


2 
10 
6 

7 


2 
9 
2 
2 


72 


llocos Sur - - 


do 


173 


lloilo 


do 


194 




do 


94 




do 


6 


Leyte - 


do 


21 


6 


265 




do . - 


7 


Misamis 


do 


7 
4 


6 
5 


40 
31 

5 
48 
49 

5 
68 
68 
23 
13 
67 
53 
13 
11 
38 
14 
14 

4 


14 
13 

1 
38 
25 

4 
42 
37 
25 
17 
29 
28 

4 
13 
18 
10 

8 


129 


Nueva Ecija 


do -..- 


99 


Nueva Viscaya 

Occidental Negros- 
Oriental Negros..- 


do 


9 


do 

do 

do 


16 
5 
2 

13 

24 
1 
3 

11 
11 


6 

2 
4 
6 
19 
4 
1 
5 
2 
..... 

9 
2 
2 

136 


169 
136 
30 


Pampanga 


de 


274 


Pangasinan 


do 


295 


Rizal 


do 


138 


Romblon 


do 


61 


Samar 


do 


165 




do 


122 


Surigao 


..do 


36 


Tarlac . 


do 


90 




do 


119 


Union 


do 


69 




.do 


61 


Zamboanga 


do 


233 


7 


Total 




1.259 


854 


882 1 399 


506 


2,713 


4.608 










. 



296 



KEPORTS RECEIVED OF INSANE PERSONS LIVING IN THE VARIOUS PROVINCES 
OF THE PHILIPPINE ISLANDS AND IN HOSPITAL. 




Abra .- 
Agusan 
Albay 

AtnboB Camarines . 

Antique 

Bataan 

Batanes 

Batangas 

Bohol .-- 

Bulacan 

Cagayan. 

Capiz 

Cavite--. 
Cebu -.-- 
Cotabato 

Davao 

Ilocos Norte 
Ilocos Sur 

Uoilo 

Laguna 
Lanao .. 
Leyte.-- 
Misamis 
Nueva Ecija 
Nueva Viscaya 
Occidental Negros. 
Oriental Negros 

Palawan do 

Pampanga 
Pangasinan 

Rizal 

Romblon 
Samar 
Sorsogon 

San Lanzaro Hos- 
pital 
Surigao 
Tarlac 
Tayabas 
Union 
Zambales 
Zamboanga 



' Americans. 7 ; Filipinos, 348 ; Other Europeans. 16 ; Chinese. 3 ; All others. 4. total. 378. 

REPORT OF SERA. 



Remain- 
ing at the 
begin- 
ning of 
the year. 



An ticholera serum (units) .-. 

Antidiphtheric serum (units) 

Antidysenteric serum (c. c.) 

Antitetanic serum (units) . 

Antityphoid vaccine (ampoules) 

Normal horse serum (ampoules) ..--. 
Staphylococcus vaccine (ampoules) 



574.000 



Received 
from the 
Bureau 

of 
Science. 



60 

2,000.000 
580 
1.511,000 
103 
12 
2 



Total to 
be ac- 
counted 
for. 



60 

2, 574, 000 

580 

1.511,000 

103 

12 

2 



I 



Issued. 



Remain- 
ing at 

end of the 
year. 



60 

1.269,000 

580 

1. 611, 000 

103 

12 

2 



1.305,000 



297 



AMOUNT OF VACCINE VIRUS DISTRIBUTED BY THE PHILIPPINE HEALTH 

SERVICE. 



Amount on hand January 1, 1J)18 

Received from the Bureau of Science 

Received from Saii?on 

Received from Shanghai 

Found at the Stations 

Total to be accounted for 

Distributed as per itemized statement 
Remaining? on hand Deceml)er 31, 1918 



Units. 

11,250 

4,289,250 

700,000 

150,000 

6,000 

5,156,500 

5,135,400 

21,100 



PLACES AT WHICH VACCINE VIRUS WAS DISTRIBUTED. 

Provinces : . Units. 

Albay 90,500 

Ambos Camarincs 73,660 

Antique 10,960 

Baguio Hospital 7,000 

Bataan 52,000 

Batanes 5,000 

Batangas 291,740 

Bohol - 15,000 

Bulacan 153,800 

Cagayan 50,440 

Capiz 8,200 

Cavite 130,400 

Cebu 746,100 

Culion Leper Colony 24,000 

Cuyo Hospital 1,000 

Ilocos Norte 141,360 

Ilocos Sur 80,770 

Iloilo 258,980 

Isabela „ 25,980 

Laguna 301,800 

Leyte . 175,000 

Masbate 500 

Mindanao 150,480 

Mindoro 46,920 

Mountain 51,980 

Nueva Ecija 112,000 

Nueva Vizcaya 12,960 

Occidental Negros 11,000 

Oriental Negros 2,000 

Palawan 8,500 

Pampanga 269,910 

Pangasinan 239,600 

Rizal 353,870 

Romblon 50,780 

Samar 45,080 

Sorsogon 56,000 

Surigao 6,980 

Tarlac 41,920 

Tayabas . 244,160 

Union ..... 72,010 

Zambales 115,450 

Total 4,535,790 

Manila : 

Health districts 658,520 

Other institutions 41,090 

Total 599,610 

Grand total 5,135,400 



298 



VACCINATIONS, CALENDAR YEAR 1918. 

[Closed March 25, 1919.] 



City of Manila: 

Health district No. 1. 
Health district No. 2. 
Health district No. 4. 
Health district No. 5. 
Health district No. 6. 



Total . 



Provinces: 

Albay 

AmbosCamarines - 

Antique 

Bataan 

Batanj^as, 

Bohol 

Bulacan 

Cagayan . 

Capiz 1 

Cat anduanes 

Cavite 

Cebu 

llocos Norte 

Ilocos Sur .- 

Iloilo 

Isabela 

Laguna 

Leyte .._ 

Mindoro 

Misamis 

Mountain 

Nueva Ecija 

Nueva Vizcaya 

Occidental Negros _ 

Oriental Negros 

Palawan 

Pampanga 

Pangasinan 

Rizal 

Romblon 

Samar 

Sorsogon 

Tarlac 

Tayabas 

Union 

Zambales 



Total 

Grand total . 



Total vac- 
cinations. 



43, 566 
119,354 

69, 715 
121,639 

60, 136 

414, 410 



64, 749 
71,713 
23, 097 
48, 322 

170, 630 
75, 095 

123, 284 
46, 235 
17, 507 
7,177 
81,171 

349,331 
86,319 
70, 739 

166, 562 
9,366 

.323, 912 

168, 447 
29, 638 
17, 653 
21, 397 
67, 636 
15,142 1 
48,887 , 
15,518 i 

6,512 : 

299,685 i 
215.997 i 
237,652 i 
14,788 ■ 
24,526 I 
34,971 i 
35, 163 i 
195,939 ! 
62,102 ' 
57,691 ! 



Total in- 
spections. 



Positive. 



7,570 
38,360 ' 
31,586 I 
29,598 ; 
47, 550 I 



3,118 
21,091 
14, 803 
14. 186 
16. 381 



154,664 



69, 579 



Negative. 



4.452 
17,269 
16,783 
15,412 
31, 169 



51.041 i 
57,863 : 
22,015 i 
31,872 : 
76,692 J 
67.664 
72, 16v5 
37. 926 
16,088 
5,390 
72, 338 

294, 288 
77, 224 
64,036 

102,513 
8.749 ■ 

211,343 
79,308 
21,328 
13, 586 
16,318 
54, 470 
14, 573 
43,748 
14,948 . 
3,741 

208.726 

192.617 

185,272 , 
9,469 
13,776 
23.373 
33,428 ' 

146. 704 
51,058 
46,938 



36,211 

37, 746 

13. 187 

15, 755 

49, 898 

39. 075 

49, 015 

23, 193 

11,215 

3,141 

43, 131 

184,328 

39, 656 

36, 942 

69,295 

2,417 

136, 036 

50. 102 

13. 474 

6.357 

7.209 

35. 733 

10, 444 

25, 462 

9.722 

2.337 

136,711 

132. 115 

117,249 

5, 439 

8,397 

14. 383 

21,471 

99, 998 

26. 549 

28. 118 



3,304,553 ! 2,442,585 ; 1,540.511 



3,718,963 2,597,249 ; 1,610,090 



85, 085 



14, 830 

20, 117 

8,828 

16. 117 

26, 794 

28, 589 

23. 147 

14, 733 

4,873 

2,249 

29, 207 

109, 960 

37, 568 

27, 094 

33,218 

6,332 

75, 307 

29, 206 

7,854 

7,229 

9,109 

18, 737 

4,129 

18, 286 

5,226 

1,404 

73,015 

60, 502 

68,023 

4,030 

5,379 

8,990 

11, 957 

46, 706 

24, 509 

18. 820 



902,074 



987. 159 



299 



MORTALITY AMONG GOVERNMENT EMPLOYEES. 



Average number of employees 

Deaths reported: 

From illness 

From violence 

Total 

Death from illness: 

Average years of pervice - _ . 

Average age at death _ _ . 

Annual deathrate per thousand _ 

Deaths from violence: 

Average years of service 

Average age at death . _ 

Annual deathrate per thousand - 

Total deaths: 

Average years of service . 

Average age at death 

Annual deathrate per thousand. 



Amer- 
icans. 



1,008 

11 

1 
12 

8.05 
86.05 
10.91 

4.17 

25.06 

.99 

7.44 
34.76 
11.90 



Both nationalities: 

Population 

Number of deaths _ . . _ 

Average years of service-.. 

Average age at death 

Annual deathrate per thousand. 



Filipinos. 



75 

1 
76 

7.58 

33.49 

7.61 

5.24 

23. 00 

.10 

7.45 

33.10 

7.61 



10, 988 

88 

7.91 

33.87 

8.00 



By gexes : male 80, female 8. 



300 

BAGUIO HOSPITAL. 

HOSPITAL CASES. 



1. Typhoid fever , . 

4. Malaria _. 

6. Measles 

7. Scarlet fever 

8. Whooping cough . - 

9. Diphtheria and croup -- 

10. Influenza 

14. Dysentery . 

19. Other epidemic diseases _ 

20. Purulent infection and septichtemia .._ 

24. Tetanus 

28. Tuberculosis of the lungs _-. 

30. Tuberculous meningitis 

34. Tuberculosis of other organs . 

37b. SyphiHs, secondary 

38b. Gonococcus infection 

47. Acute articular rheumatism 

50. Diabetes -. ._ _. _ 

54. Anaemia, chlorosis __ - 

55. Other general diseases 

56. Alcoholism (acute or chronic) _ 

66. Paralysis without specified cause 

68. Other forms of mental alienation . 

71. Convulsions of infants 

73b. Neuralgia and neuritis 

74. Other diseases of the nervous system 

75a. Follicular conjunctivitis 

75b. Trachoma 

75c. Other diseases of the eyes and their annexa 

76. Diseases of the ears 

81. Diseases of the arteries, atheroma, aneurysm, etc 

83. Diseases of the veins (varices, haemorrhoids, phlebitis, etc). 

86. Diseases of the nasal fossae 

87. Diseases of the larynx 

89. Acute bronchitis 

91. Bronchopneumonia .. 

92. Pneumonia 

93. Pleurisy 

96. Asthma 

99a. Diseases of the teeth and gums 

99b. Other diseases of the mouth syid annexa 

102. Ulcer of the stomach 

103. Other diseases of the stomach (cancer excepted) 

104. Diarrhoea and enteritis, under 2 years 

105. Diarrhoea and enteritis, two years and over 

105a. Due to alcoholism. 

107. Intestinal parasites _ 

108. Appendicitis and typhlitis 

109. Hernia, intestinal obstruction - 

110a. Diseases of the anus and faecal fistula 

UOb. Other diseases of the intestines 

112. Hydatid tumor of the liver 

116. Diseases of the spleen 

119. Acute nephritis 

120. Bright's disease .- 

122. Other diseases of the kidneys and annexa 

124. Diseases of the bladder 

125. Diseases of the urethra, urinary abscess, etc... 

126. Diseases of the protate 

127. Non venereal diseases of the male genital organs 

130a. Metritis 

130b. Other diseases of the uterus 

131. Cysts and other tumors of the ovary 

132. Salpingitis and other diseases of the female genital organs .- 

134a. Normallabor 

134b. Accidents of pregnancy 

136. Other accidents of labor 

142. Gangrene 

143. Furuncle 

144. Acute abscess.-- ._. 

145b. Scabies 

145c. Other diseases of the skin and annexa _ 

151a. Nursling discharged from hospital without disease 

161-1. Premature birth (not stillborn) 

161-2. Congenital debility. 



1 i. 

47 L 
34 ■. 

3 . 
11 . 

4 . 
146 I 

2G i 
40 ;. 

3 ,- 
1 L 

100 I 
1 i 

4 !. 

3 ;. 
10 i. 
17 L 

1 i- 

4 '. 

li; 

4 ■ 
1 i. 

5 I 
3 L 

1 i- 

5 L 
3 L 

19 i- 

3 . 

1 - 

1 . 

3 . 
98 . 
12 
46 

8 . 

4 . 
1 . 

21 . 

6 . 
50 
10 

19 . 

1 . 
3 . 

2 . 

1 - 

3 . 

5 . 

2 _ 
2 . 
8 

3 

2 . 

1 - 

1 - 

2 . 

10 . 
2 . 

8 . 
3 

2 - 

67 . 

20 . 
5 

11 . 
11 . 

9 . 

6 _ 

4 . 
57 . 

1 
1 > 



5 

20 



I 

46 

34 

3 

11 

4 

142 

24 

40 

3 

1 

103 

..... 

2 
10 

17 
1 
4 
2 
1 
3 
1 
4 
3 
1 



19 

4 



97 
6 

26 
8 
4 
1 

21 
6 

48 
9 

19 
1 
2 
2 
1 
3 
5 
2 
2 
7 
3 
2 
1 
1 
2 

10 
2 
8 
2 
2 

56 

20 
5 

11 

12 
8 
6 
4 

56 



301 

BAGUIO HOSPITAL— Conlinueo. 
HOSPITAL CASES— Continued. 






164. Poisoning- by food 

167. Burns (conflagration excepted) -. 

170. Traumatism by firearms . 

171. Traumatism by cutting or piercing instruments 

172. Traumatism by fall 

173. Traumatism in mines and quarries 

174. Traumatism by macbines 

175. Traumatism by other crushing (vehicles, railways, 

elides, etc.) 

176. Injuries by animals 

185b. Sprains 

185c. Fractures (cause not specified) 

199b. No disease, feigned disease 



land- 



Tot <«L 



! < 



5 
5 
7 
33 
4 
4 

1 i 

11 
1 

rj 

12 
9 



15 1,127 



3 
6 

8 
33 

4 
4 

1 



42 



Number of patients treated in the outdoor department at the Baguio Hospital, 4,498. 
BAGUIO HOSPITAL. 
TABLE OF DEATHS. 



11 




1 




5 




12 




9 




1.081 


19 



Date. 



1918. 

January 25--. 

February 7-. 
13-. 
15- 
25.. 

March 1 

April 1 



May 



July 



4 

14 

21 

9 

22 

June 23 

25 

25 

2 

17 

28 

August 2 

5 

5 

September 28- 

October 1 

28 

November 18. 

19. 

20. 

20- 

22. 

23. 

25., 

25. 

26. 

27. 

28. 

December 2 — 

2._-. 

6.-. 

6._- 



9.. 
10. 
13. 



Nationality. 



Adult or 
child. 



Filipino Adult .. . 



-do 
-do 
-do 
.do 

.do Child 

-do Adult 



do ... 

do... 

do ... 

Chinese . 
Filipino . 
do ... 

do . 

do . 



Child . . 

do. 

do. 

do . 

do . 

do . 

do . 

Adult-. 



.do Child 



Adult.. 
Child .. 

do . 

Adult-. 



do I Child 



do 

do 

do 

do 

do 

do 

do 

do 

do 

— -do 

do 

— do 

do 

do 

do 

— .do 

do 

do 

do 

do 

— .do 

do 



Adult- . 
do . 

Child-. 
do . 

Adult.. 

do. 

do . 

do. 

do . 

do . 

do. 

do . 

do . 

do. 

do . 

do . 

Child.. 

Adult.. 

do. 

do . 

do . 

do. 



1 Sex. 



M. 
F. 
M. 
M. 
M. 
M. 

M. 
F. 
M. 
M. 
M. 
F. 
M. 
F. 
M. 
M. 
F. 
F. 
M. 
M. 
F. 
M. 
M. 
F. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 
F. 
M. 
M. 
M. 
M. 
M. 
F. 
M. 



Causes of death. 



Mitral regurgitatis. Cardiac dilatation. 

Lobar pneumonia. 

Ovarian cyst. 

Pneumonia. 

Nephritis, acute. 

Meningitis, tubercular. 

Transverse, traumatic. Myolitis complicated 

by hypostatic pneumonia. 
Acute gastroenteritis. 
Ptomaine poisoning. 
Pneumonia. 
Bronchopneumonia. 
Acute gastro enteritis. 
Pneumonia. 
Bacillary dysentery. 

Grippe complica<-ed with bronchopneumonia. 
Acute gastroerteritis. 
Acute tubercular pulmonary. 
Infantile Convulsion. 
Acute ptomaine poisoning. 
Pneumonia. 
Pneumonia. 

Rupture of sac ectopic gestation. 
Cancer of the stomach. 
Bronchopneumonia. 
Pneumonia. 

Do. 
Pneumonia following grippe. 
Bronchopneumonia following grippe. 

Do. 
Pneumonia following grippe. 

Do. 

Do. 
Pulmonary tuberculosis. 
Pneumonia following grippe. 

Do. 
Influenza; pneumonia, lobar. 
Pneumonia following grippe. 
Congenital debility. 
Influenza; pneumonia, lobar. 
Pneumonia following grippe. 
Bronchopneumonia. 

Do.. 
Lobar pneumonia following grippe. 



302 

BAYOMBONG HOSPITAL. 

HOSPITAL CASES. 



Diseases. 



4. Malaria 

4a. Malarial cachexia . 

5. Smallpox 

9. Measles 

10. Influenza . 

14. Dysentery 

19. Other epidemic diseases 

20. Purulent infection and septichaemia 

23. Rabies 

27. Beriberi 

28. Tuberculosis of the lungs 

28b. Gonococcus infection ..-. 

47. Acute articular rheumatism 

48. Chronic rheumatism and gout 

54. Anaemia, chlorosis 

61. Simple meningitis , 

71. Convulsions of infants 

75c. Other diseases of the eyes and their annexa 

76. Diseases of the ears 

86. Diseases of the nasal fossae 

89. Acute bronchitis 

92. Pneumonia 

93. Pleurisy 

100. Diseases of the pharynx 

102. Ulcer of the stomach 

103. Other diseases of the stomach (cancer excepted) 

105. Diarrhoea and enteritis (2 years and over) 

107. Intestinal parasites 

109, Hernia, intestinal obstruction 

118. Other diseases of the digestive aystem (cancer and tuberculo- 

sis excepted) 

119. Acute nephritis... .' : 

124. Diseases of the bladder 

132. Salpingitis and other diseases of the female genital organs 

137. Puerperal septichaemia 

143. Furuncle 

144, Acute abscess 

145b. Scabies 

145c. Other diseases of the skin and annexa 

171. Traumatism by cutting or piercing instruments 

186. Other external violence 

189a. Causes of death not specified or illdefined 



80 

7 

2 

1 
16 

4 

6 

1 ! 

4 I 

4 

3 

1 

2 

4 

3 



Total . 



3| 

1 

1 

5 

2 

1 

3 

1 

9 

1 

8 

1 

2 I 

1 i 

1 I 

2 I 
1 I 
4 ■ 
5 

18 
1 
8 
2 
1 

228 





i 


be 




bo 


c 




J3 


c 




x: 




■^ 


o 


£ 








Q 


5 


05 




82 




1 


7 
2 




1 






1 


15 
4 
6 
1 






4 




1 


3 
3 
1 
2 
4 
3 
6 
2 
3 
1 
1 
5 





1 


1 
1 
3 




1 


1 
8 




1 








3 




1 








1 






3 






1 




:::::: 


4 
5 





303 

BONTOG HOSPITAL. 

HOSPITAL CASES. 



go 



2^ 



+J i P 



-I 



3 



-I- 



1. Typhoid fever - - 

4. Malaria -- - 

6. Measles 

10. Influenza 

14. Dysentery 

17. Leprosy 

19. Other epidemic diseases 1 

20. Purulent infection and septichaemia 

22. Antrax 

27. Beriberi 

28. Tuberculosis of the lungs 

37b. Syphilis, secondary 

38b. Gonococcus infection 

47. Acute articular rheumatism 

54. Anaemia, chlorosis 

61. Simple meningitis 

73b. Neuralgia and neuritis 

74. Other diseases of the nervous system 

66. Paralysis without specified cause , 

75a. Follicular conjunctivitis 

75c. Other diseases of the eyes and their annexa 

76. Diseases of the ears - 

84. Diseases of the lymphatic system (lymphangitis, etc.) 

87. Diseases of the larynx 1 

88. Diseases of the thyreoid body ; 

89. Acute bronchitis i 

90. Chronic bronchitis -• , 

91. Bronchopneumonia i 

98. Other diseases of the respiratory system (tuberculosis ex- ! 

cepted) , 2 

99b. Other diseases of the mouth and annexa 

103. Other diseases of the stomach (cancer excepted) j 

104. Diarrhoea and enteritis (under 2 years) ; 

105. Diarrhoea and enteritis (2 years and over) 1 

106. Ankylostomiasis j 

107. Intestinal parasites \ 

110. Other diseases of the intestine i 

113. Cirrhosis of the liver j 

115. Other diseases of the liver 1 

120. Bright's disease i 

123. Calculi of the urinary passages [ 

127. Nonvenereal diseases of the male genital organs 1 

130. Other diseases of the uterus j 

134, Accidents of pregnancy 

140. Following childbirth (not otherwise defined) 1 

143. Furuncle I 

144. Acute abscess 1 2 

145a. Trichophytosis (tineas and peladas) ! 18 

145b. Scabies ■ 1 

145c. Other diseases of the skin and annexa .j 2 

146. Di seases of the bon es (tuberculosi s excepted) 1 

147. Diseases of th« joints (tuberculosis and rheumatism excepted) -_i 

151. Congenital debility, icterus, and sclerema } 1 

164. Poisoning by food -_. 1 1 

167. Burns (confiagration excepted) ; i 

171. Traumatism by cutting or piercing instruments 1 i 

176. Injuries by animals j i 

185a. Dislocations I 

185c. Fractures (caus*^ not specified) 

186. Other external violence 

189a. Cause of death not specified or illdefined 

Total j 28 I 



22 
15 
10 
241 
11 
11 
40 
35 

1 

3 

2! 

11 

1 I 

4 ' 
5 
1 
3 
3 
15 
6 
5 



713 



^ i 



12 
3 




21 




5 




28 


i 


2 




1 




3 




4 




3 




1 




5 




4 




17 


i 


4 




25 




52 




3 




1 




1 


1 


1 




5 


3 


12 




3 




3 




2 




9 




2 





22 
14 
9 
221 
10 
14 i 
40 I 
32 I 

l\ 

13 i 
1 I 
6 



4 




4 




2 




5 




2 




1 




7 




3 


1 


4 


1 


1 




3 




3 




15 




6 




5 




2 




4 




12 




3 




20 


1 


5 




27 




2 




1 




3 




4 




1 


2 


1 




5 




3 


1 


15 


1 


4 




2 




43 




1 




53 


1 


3 




1 




1 




2 




11 


1 


3 




3 




2 




8 


1 


2 




698 


28 



Patients treated in the outdoor department at the Bontoc Hospital, 5,385. 
Cases treated in the outdoor department at the Bontoc Hospital, 2,068. 

Cases treated in the provincial health stations by medical oflficers or assistant sanitary inspec- 
tors, 30,787. o n xz 



304 

BONTOC HOSPITAL. 

LABORATORY EXAMINATIONS. 

Specimen. Number. 

Blood 15 

Faeces 87 

Nose discharge 1 

Pus 2 

Sputum 18 

Urine 25 

Urethral discharge 1 

Total 149 

MISCELLANEOUS. 

Patients admitted.. 713 

Patients remaining from last year 28 

Hospital days 9,239 

Average hospital days per patient .*. 13.22 

Daily average per patient 25.33 

Deaths 15 

CHINESE HOSPITAL-SICK REPORT. 

[Dr. Tee Kan Kee, Physician in Charge.] 

In hospital at last year 43 

Received during the year 658 

Discharged 512 

Died 147 

Remaining in hospital at end of the year 42 

CITLION LEPER COLONY. 





Americans. 


Europeans. 


Filipinos. 


Status. 


13 

4 
3 

1 






1 


Male. 


Female. 


Remaining at last report 

Admitted 


2 




2,858 

661 

21 

47 

558 

6 

21 

3,002 


1,604 

302 

5 

28 

271 

5 

1 

1,662 


Readmitted-. . 
















Died 






2 


v..—. 




1 














7 

















Chinese. 


Others. 






aJ 




0) 




13 


13 
S 


13 


1 


13 


5 




8 


4 


4,485 


^ 




4 




973 
27 










75 






1 


2 


834 










12 










22 


8 




11 


2 


4.692 



30c 



CUYO HOSPITAL. 

HOSPITAL CASES. 



Diseases. 



4a. Malarial cachexia 

10. Influenza 

14. Dysentery 

18, Erysipelas 

21. Glanders -: 

28. Tuberculosis of the lungs ..'. 

44. Cancer and other malignant tumors of the skin 

47. Acute articular rheumatism 

48. Chronic rheumatism and gout. _. 

65. Softening of the brain 

68, Other forms of mental alienation 

74. Other diseases of the nervous system .-. 

75a. Follicular conjunctivitis 

75c. Other diseases of the eyes and their annexa _• 

76. Diseases of the ears 

86. Diseases of the nasal fossae 

89. Acute bronchitis 

91. Bronchopneumonia 

92. Pneumonia 

96. Asthma 

103. Other diseases of the stomach (cancer excepted) 

106. Ankylostomiasis 

107. Intestinal parasites 

108. Appendicitis and typhlitis 

109. Hernia, intestinal obstruction 

UOb, Other diseases of the intestines 

113a. Due to alcoholism 

116. Diseases of the spleen 

118. Other diseases of the digestive system (cancer and tuberculosis 

excepted) 

119. Acute nephritis 

128. Uterine haemorrhage (nonpuerperal) 

130b. Other diseases of the uterus 

134a. Normal labor 

136. Ot:her accidents of labor 

145 . S ;abies 

145c. Other diseases of the skin and annexa 

147. Diseases of the joints < tuberculosis and rheumatism excepted) . 

152. Other diseases peculiar to early infancy 

153. Lack of care 

I65a. Venomous bites and stings 

166. Conflagration 

171. Traumatism by cutting or piercing instruments 

186. Other external violence 



tf"" 



Total 







?; 


M 


1 




» 


'2 














JC 




B 


'^ 


00 


§ 


< 


Q 


Q 


« 


23 


1 


22 




12 




12 




3 




3 








1 






1 








7 








1 








4 
1 








2 








1 






2 






! 1 








1 








1 








1 








2 








1 








2 








1 




17 


17 








9 




11 




11 








3 




1 


1 









1 








1 








1 








1 








3 










1 






4 




2 




2 




1 




1 




3 




3 




2 




2 




2 




2 




2 




2 




1 




1 




3 




3 




1 




1 




1 






1 


1 




1 




138 


2 


136 


2 



Number of patients treated during the year- 
Number of surgical dressings 

Number of minor operations performed 

Number of presciptions filled 



4,19S 

2,114 

162 

1.635 



SAN LAZARO HOSPITAL. 
INSANE DEPARTMENT. 





Americans. 


Europeans. 


Filipinos. 


Chinese. 


others. 




Status. 


0) 

6 
30 
25 

2 




6 




1 




_l_ 

6 
45 

47 

1 


13 
B 


1 


6 
1 


H 


In hospital at last year 

Admitted 




13 
4 
2 
2 


2 

1 


302 

164 

59 

46 

8 

100 

253 


105 
71 
35 
30 


3 
10 
5 

1 


.._.__ 


437 
326 


Discharged 

Transferred 

Escaped ._ 


178 
82 
g 


Died 


2 

7 








16 
95 






4 
3 


-_.._. 


122 


Remaining 




13 


3 


3 




378 



306 

SAN LAZARO HOSPITAL— Continued. 
LEPER DEPARTMEMT. 



Statue. 



In hospital at last year 

Admitted _._ 

Discharged __. 

Transferred 

Escaped 

Died ..._ _ 

Remaining 



Americans. 



Europeans. 



Filipinos. 











i 


a 


s 


^ 


96 


46 


202 


85 


25 


9 


167 


87 


32 


11 


8 


1 


66 


23 



Chinese. 


Others. 


2 
10 

7 
2 
2 

1 


v 
rt 

1 


5} 

1 


1 


1 
1 














































LD FOLK'S 
Americans. 

1^ PL< 


HOME DE 
Europeans. 


PARTMENT. 
Filipinos, j Chir 


lese. 

'3 

J 


Others. 


- - 


Status. 


15 




1 


6 
"3 
B 

<u 

p^ 

17 
32 
10 
4 


S 


6 

1 
1 




1 


In hospital on last year ... 








14 

42 
9 




32 


Admitted 


4 
2 












79 


Discharged _. 












21 


Transferred 












1 




13 


Escaped 




1 








Died 


2 








19 
20 


14 
21 










35 


Remaining 












1 





42 





















Death rate, 31.53 per cent. 
TUBERCULOSIS DEPARTMENT. 





Amer 


cans. 


Europeans. 


Filipinos. 


Status. 


1 


6 
B 

(X4 


6 

1 




6 

58 

419 

260 

1 

179 
35 


6^ 


In hospital on last year -.. 






1 
5 
2 
2 




26 


Admitted 


6 
2 
1 




207 


Discharged ._ . 


131 


Transferred . . 


2 


Escaped _ ... 




Died 


2 

1 




1 
1 




72 


Remaining _ . 


28 







Death rate, 15.99 per cent. 
OBSERVATION DEPARTMENT. 



Chinese. 



Others. 





Amer 


cans. 


Europeans. 


Filipinos. 


Chinese. 


Oth 

1 


ers. 

<D 

-3 

B 




Ststus. 
In hospital on last year 


6 




13 


1 
1 


0) 

1 


,2 


jj 




J, 


Admitted . 


6 
5 

1 


2 


1 




18 
10 
6 
2 


5 
3 
2 


1 




i 




34 


Discharged _. 


18 


Transferred 


2 


1 




1 




1 




14 


Died 


2 


Remaining 













































307 



SAN LAZARO HOSPITAL— Continued. 

RKMARKS. 

Discharged : 

2 Americans male under observation for smallpox and plague. 

2 Americans male not smallpox. 
1 American male unknown. 

3 Filipinos male unknown. 

4 Filipinos male not smallpox. 
I P^ilipino male not measles. 

1 Filipino male not varioloid. 

2 Filipinos female not measles. 
1 Filipino female not varioloid. 

1 Filipino male under observation for bubonic plague. 
Transferred : 

1 American male to smallpox department. 

1 American female to varioloid department. 

1 American female to smallpox department. 

1 European male to smallpox department. 

4 Filipinos male to smallpox department. 

1 Filipino female to measles department. 

1 Filipino female to smallpox department. 

1 Filipino male to measles department. 

1 Filipino male to grippe department. 

1 Chinese male to smallpox department. 

1 Other male to smallpox department. 
Died : 

1 Filipino male due to bilateral empyema. 

1 Filipino male due to lobar pneumonia. 

CHOLERA DEPARTMENT. 





1 Amer 

i 13 
1 ^ 

1 

I 7 

__-.; 1 


icans. 

B 

...... 

1 


Europeans. 


Filipinos. 


Chinese. 


Others. 


Status. 

In hospital on last year 

Admitted 

Discharged . 


...... 


13 
£ 

...... 

1 


S 
13 

"254" 

159 

16 

1 

75 

3 


6 

2 

128 
89 
9 


S 


1 


6 

1 


6 
15 
S 




2 




4 
4 




1 


1 












Died 


i 




1 


29 
3 


1 








Remaining 

















2 
401 
261 
28 

1 
107 

6 



Death rate 26.55 per cent. 

Remarks : Of the above 403 cases, admitted, 



were cholera vibrio carriers. 
SMALLPOX DEPARTMENT. 





Americans. 


Europeans. 


Filip 


inos. 


Chii 


lese. 

6 

13 

Si 


Others. 




Status. 


! ^ 
13 

1 


6 
13 
6 

0) 


S 


i 


13 






13 
6 


1 








Admitted 

Discharged 


::::!""25" 

...i 19 

....; 1 


6 
3 


4 
3 


2 

1 


571 

266 

8 


452 

232 

2 


5 
3 

1 


I 


9 
4 
2 


2 
1 


1.079 
533 
14 












Died 

Remaining 


4 

.....i 1 


3 


1 


-..-- 


296 
1 


217 

1 


1 


2 


3 


1 


528 
4 

















Death rate, 48.93 per cent. 



308 

SAN LAZAHO HOSPITAL— Continued. 
VARIOLOID DEPARTMENT. 





Americans. 


Europeans. 


Filipinos. 


Chinese. 


Others. 




Status. 




s 


6 


13 


.2 




1 


E 


1 


i 
1 


3 


In hoBpital on last year _ . 
















Admitted . _. 


18 
16 
2 


• 15 

14 

1 


2 
2 


1 

1 


449 
409 
32 


347 
317 
20 


6 
4 


1 


16 
13 
2 

1 


5 

4 


860 


Discharged 


780 


Transferred 


57 


Escaped ._ 




3 4 
5 6 


2 


1 


12 


Died 








11 


Remaining .. 




















" 























Death rate 1.27 per cent. 



VARICELLA DEPARTMENT. 





Americans. 


Europeans. 


Filipinos. 


Chinese. 


Others. 




Status. 
In hospital on last year 


Male. 
Female. 


1 


6 
£ 


6 

1 






c5 
13 
S 


1 


6 


1 


Admitted 


i 1 


2 
1 

1 


1 9 

; 8 

1 


4 
2 
2 


1 




i 
1 


2 
2 


20 


Discharged 'T' . .. 


- - \ 




14 


Transferred 


1 


1 




6 


Escaped . 






1 






Died . . - 


i" 




1 


i 






Remaining 


1 


i ! 
































RlilMARKS. 

Four cases were transferred to varioloid department. 
Two cases were transferred to smallpox department. 
Death rate, per cent. 

MEASLES DEPARTMENT. 





1 Americans. 


Europeans. 


Filipinos. 


Chinese. 


Others. 




Status. 


QJ 

13 

.... 1 
...J 9 
...-i 10 


6 
13 
S 
o 


15 


6 
13 

1 


6 

3 
292 
222 

5 


6 
13 
£ 


13 


6 
13 

I 


1 


6 

S 


3 


In hospital on last year 




4 


Admitted 

Discharged 

Transferred-- 


ii 
11 


2 
2 


3 
3 


136 
129 

5 


' 




2 
2 


5 
5 


461 

385 

10 


Escaped i..- 
















Died _.. 






4 
64 


2 










6 


Remaining 1- ' 














64 




I 




" 

















One Filipino male admitted as measles with numps. 
One Filipino female, admitted as measles with tonsilitis. 
Death rate, 1.3 per cent. 



309 

SAN LAZARO HOSPITAL— Continued. 
DIPHTHERIA DEPARTMENT. 





i Americans. 

i 1 6 

: S 1 fa 
1 


Europeans. 

i i s 

s I fa 


Filipinos. 

1 1 


Chinese. 

1 dj 

1 i £ 

! 


Others. 




Status. 


S 
« 
S 


i 


1 


In hospital on last year 




Admitted 


...J 8 ! 1 

..-.! 8 : 1 


1 


41 
32 


22 
17 








75 


Discharged 


; 






59 


Transferred 








1 


















Died 




1 


9 


5 








15 


















! 






: 









Death rate, 20 per cent. 



TYPHOID AND PARATYPHOID DEPARTMENT. 



Status. 


Amer 


icans. 

0) 

6 
J" 
fa 


, Eurot 


Deans. 

13 

e 

fa 


Filip 

6 

13 

5 
27 
21 

4 


inos. 

13 
S 


Chii 

13 


lese. 


0th 

s 

13 


ers. 

u 

g 

fa 


1 


In hospital on last year 






1 
14 
13 

1 




6 


Admitted 


1 




1 












42 


Discharged 




1 












34 


Transferred 


r " --|--- -- 












5 


Escaped - - ._ . 


i i 














Died 


1 








7 


1 










9 


Remaining 




! 







































REMARKS. 

Three cases were paratyphoid fever, being discharged, 2, and transferred 1. 
One case of typhoid fever, was discharged as grippe fever. 
Death rate, 25 per cent. 

DYSENTERY DEPARTMENT. 





Americans. 


Europeans. 


Filipinos. 


Chinese. 


Others. 




Status. 


13 


13 
S 
<v 

fa 


q5 

1 


13 
fa 




13 
fa 




13 
S 


dJ 


-2 

1 


5 
5 


In hospital on last year 










1 

100 
73 
5 












1 


Admitted _. . . 


4 
3 





1 

1 




60 
40 
5 


1 




3 
2 




169 


Discharged 


119 


Transferred 






10 


E -scaped - 




















Died 


1 








22 
1 


15 


1 




1 




40 


Remaining _ 








1 














, 











Death rate, 23.52 per cent. 



310 



SAN LAZARO HOSPITAL— Continued. 
TETANUS DEPARTMENT. 





Americans. 


Euroi 


jeans. 

E 


Filip 

S 

15 

41 
15 


inos. 

13 
B 


Chinese. 

1 . 

i \ 1 

! 


Others. 




Status. 
In hospital on last year 


13 


Si 


<i5 


6 
13 




1 


Admitted 


1 
1 




j 


1(J 

5 






52 


Discharg'ed 








1 L __. 




21 


Transferred 








! 




1 


Escaped _ 












j i 






Died . . 










26 


5 


I 




81 


Remaining' 










1 ' 































Death rate, 58.49 per cent. 

VENEREAL DISEASES. 
GONORRHEAL DEPARTMENT. 





Americans. 


Europeans. 


Filipinos. 


Chir 

6 
13 


lese. 

V 

13 

1 


Others. 

i 1 




Status. 


S 


6 
15 
S 


6 

1 


15 
S 


6 

1 

1 
8 
6 

1 


13 
£ 


1 


In hospital on last year _ ^ 


1 


Admitted 










40 

39 

1 








48 


Discharged _. __ . . 















45 


Transferred - . . 












_ 




2 


Escaped - -. 












Died 










1 

1 










1 


Remaining _ - 












j 






1 

























Seven Filipinos male, were admitted as gonorrheal ophthalmia. 

One Filipino female, admitted as gonorrheal ophthalmia. 

Two Filipinos male, were admitted as gonorrheal urethritis. 

Thirty-nine Filipinos female, were admitted as gonorrheal urethritis and cervicitis. 

One Filipino male, died of gonorrheal ophthalmia. 

One Filipino male, was transferred to insane department as dementia praecox. 

One Filipino female, was transferred to cholera department as cholera vibrio carrier. 

Death rate, 2.04 per cent. 

SAN LAZARO HOSPITAL. 
GRIPPE DEPARTMENT,. 





Amer 


icans. 


Europeans. 


Filipinos. 


Chinese. 


All others- 




Status. 


6 


S 
13 

1 


1 


13 
g 


6 
13 


13 
S 


i 


S 




13 

B 


5 


In hospital on last year. 
























Admitted 










9 
6 
3 










9 


Discharged 


















6 


Transferred _-. .. 


















8 


Escaped 




















Died ::::.: 
















r 




Remaining 





































311 

SAN LAZARO HOSPITAL— Continued. 
MUMPS DEPARTMENT. 



Status. 


Americans. 

i 


Europeans. 

1 i 
i 1 i 

s 1 ^ 

--1 -■- 

1 


Filip 

A 

4 
136 
115 

2 


inos. 

!"■ 

1 
26 
27 


Chinese. 

! 6 

i i § 

1 


All others. 

i 1 


1 

6 


Admitted 






1 


1 






162 






" 


1 








142 


Transferred 








i 

1 — 






2 






















Died 










2 
21 










2 




















21 












" 











Remarks. 



Two cases died due to lobar pneumonia. 
Death rate, 1.19 per cent. 



MISCELLANEOUS DEPARTMENT. 



Status. 


Amer 

l_ 

1 

1 


icans. 

B 


Euro J 


)eans. 

"7" 

1 


Filip 


inos. 

S 

1 


Chir 


lese. 


0th 


ers. 

a 
f2 


Remaining on last year 

Admitted 







4 
18 
16 
3 
3 










17 
13 
3 
1 


1 

1 




















Transferred 


1 












Died 










. 




Remaining 


i 










1 

























Remarks. 
In this department were included the following cases : 



Gastro-enteritis 

Enteritis 

Gastritis 



Entero-colitis 

Ring-worm 

Diarrhoea 

Trichiuris 

Ankylostomiasis 

Boil 

Whoop ing-cough 



Scabies 

Cerebral haemorrhage 

Arthritis deformed 

Orchitis - 

Child-birth 

Yaws 

Pneumonia 

Puerperium 

Mastitis 



5 
37 
30 
7 
4 
1 



16 
1 
1 
1 
2 
1 
5 
1 
1 



Died: 3 cases due to lobar pneumonia. Died: 1 case due to puerperal insanity. 



REPORT OF SPECIMEN FORWARDED TO THE BUREAU OF SCIENCE FOR LABOR- 
ATORY EXAMINATIONS DURING THE YEAR 1918. 

Specimen. Number. 

Blood -■ 74 

Diphtheria ; 427 

Faeces Z,9SZ 

Conococcus 148 

Sputum -- 469 

Urine - 5 

Total 5,106 



312 

SAN LAZARO HOSPITAL. 

MORGUE AND CREMATORY DEPARTMENT. 

Number 
Disposition. of 

bodies. 

Remaining from last year 1 

Received : 

Abdominal tuberculosis 3 

Acute bronchitis 1 

Acute miliary tuberculosis ~ 3 

Acute nephritis 1 

Alcoholism (acute or chronic) 1 

Beriberi 2 

Bronchopneumonia ., 15 

Cancer and other malignant tumors of the breast 1 

Cerebal haemorrhage, apoplexy 2 

Cholera 126 

Probable cholera 35 

Congenital debility - 2 

Convulsions of infants 1 

Diarrhoea and enteritis 4 

Diphtheria - 14 

Probable diphtheria.. 1 

Diseases of the arteries, atheroma, aneuryams, etc 2 

Diseases of the mouth and annexa 1 

Dysentery - 49 

Following childbirth (not otherwise defined) 1 

Gangrene 1 

Hernia, intestinal obstruction 1 

Influenza - 3 

Leprosy 9 

Malaria - 3 

Measles 6 

Other diseases of the heart 5 

Other diseases of the nervous system 1 

Other diseases of the spinal cord 1 

Other forms of mentals alienation 59 

Pneumonia ^ 33 

Senility ^ - - , -- 35 

Simple meningitis + 2 

Smallpox -... 984 

Probable smallpox 4 

Stillbirths 3 

Syphil's .-- 1 

Tetanus 34 

Tuberculosis of other organs 1 

Tuberculosis of the lungs 293 

Typhoid fever 9 

Varioloid _ H 

Other diseases 121 



Total 



Dropped : 

Bur;ed by Bureau of Prisons 13 

Buried by Chinese cemetery 9 

Bur-ed by city 750 

Buried by family 872 

Crema+ed 123 

Turned over to army morgue 2 

Turned over to c'ty morgue 1 

Turned over to family 113 

Remaining at end of the year 8 

Total 1,886 

Number of autopsies held, 316. 



313 

PRISON SANITATION. 

BILIBID PRISON REPORT OF SICK. 



Diseases. 



6t 



1. Typhoid fever 

4. Malaria 

5. Smallpox 

6. Measles 

8. Whoopinf? cough 

10. Influenza 

Cholera vi brio carriers 

14. Dysentery 

17. Leprosy 

19. Ocher epidemic diseases 

20. Purulent infection and septichasmia 

27, Beriberi j 

28. Tuberculosis of the lungs ; 44 

31. Abdominal tuberculosis ; 

33. White swellings 



34. Tuberculosis of other organs 

35. Disseminated tuberculosis 

37a. Syphilis, primary 

37b. Syphilis, secondary 

37c. Syphilis, tertiary 

38a. Soft chancre 

38b. Gonococcus infection 

46. Other tumors (tumors of the female genital organs ex- 

cepted) -._ 

47. Acute articular rheumatism 

48. Chronic rheumatism and gout 

55, Other general diseases 

59. Other chronic poisonings 

61. Simple meningitis 

64. Cerebral haemorrhage, apoplexy 

68. Other forms of mental alienation 

69. Epilepsy 

73a. Hysteria 

73b. Neuralgia and neuritis 

75b. Trachoma 

75c. Diseases of the eyes and their annexa 

76. Diseases of the ears 

79. Organic diseases of the heart 

81. Diseases of the arteries, atheroma, aneurysm, etc 

88. Diseases of the veins (varices, haemorrhoids, phlebi- 
tis, etc.) 

84. Diseases of the lymphatic system (lymphangitis, etc.).. 

85. Haemorrhage; other diseases of the circulatory system. 

86. Diseases of the nasal fossae 

87. Diseases of larynx 

90. Chronic bronchitis 

91. Bronchopneumonia 

92. Pneumonia 

93. Pleurisy 

94. Pulmonary congestion, pulmonary apoplexy 

95. Gangrene of the lungs 

96. Asthma 

98. Other diseases of the respiratory system (tuberculosis 

excepted) 

99a. Diseases of the teeth and gums 

99b. Other diseases of the mouth and annexa 

100. Diseases of the pharynx 

103. Other diseases of the stomach (cancer excepted) 

105. Diarrhoea and enteritis (2 years and over) 

106. Ankylostomiasis 

107. Intestinal parasites 

108. Appendicitis and typhlitis ' 

109. Hernia, intestinal obstruction 

110a. Diseases of the anus and faecal fistulas 

110b. Other diseases of the intestine 

114. Biliary calculi 

115. Other diseases of the liver 

116. Diseases of the spleen 

119. Acute nephritis 

120. Bright's disease __. 

122. Other diseases of the kidneys and annexa 

123. Calculi of the urinary passages 

124. Diseases of the bladder 

125. Diseases of the urethra, urinary abscess, etc 

127. Nonvenereal diseases of the male genital organs 



1 

e 

< 
1 




1 

c 
cd 


i 

s 
1 

24 

""ll 
2 

756 
1 

150 


00 

G 

'5 
£ 


27 

5 

17 


3 


" "3' 


2 


2 


i 




777 
1 




13 


8 


152 
3 


2 


...... 


1 


210 


217 

29 

9 

18 
6 


2 


30 






1 


12 

135 

16 

1 


ii8 

10 




3 
43 


9 
It 


2 

1 




9 




6 




5 
14 
30 

6 
33 

18 
51 
32 
53 
10 


1 


14 








29 






2 


7 






1 


28 






1 


18 








50 






1 


30 






3 


53 








12 






2 


1 


i 
1 






2 






1 


6 


6 






2 

2 


2 

2 
1 
112 
134 
7 
3 
1 

24 
5 
3 

11 
3 
1 
3 

55 

10 




1 








112 








134 






4 


7 








6 

1 

25 


3 

1 





3 


5 








3 








11 








3 








1 








5 

90 
15 

1 


2 
36 

1 
1 
1 


...... 


3 

4 


1 








29 




30 

27 
29 
6 
3 

67 

89 

793 

1168 

2 

33 

25 

17 

1 

4 


1 


27 








29 








6 








4 






1 


67 








89 








805 






14 


1175 






11 


3 
34 


1 




2 


25 








17 








1 








5 
1 


1 
1 

1 
4 






1 








9 
1 




6 
1 
1 
1 
2 
89 




1 








1 








2 








88 






2 



314 



PRISON SANITATION— Continued. 
BILIBID PRISON REPORT OF SICK-Continued. 



128. Uterine haemorrhaj?e (nonpuerperal) 

133. Nonpuerperal diseases of the breast (cancer excepted) . . . 
136. Other accidents of labor 

143. Furuncle 

144. Acute abscess 

145a. Trichophytosis (tineas and peladas) 

145b. Scabies 

145c. Other diseases of the skin and annexa 

146. Diseases of the bones (tuberculosis excepted) 

147. Diseases of the joints (tuberculosis and rheumatism ex- 

cepted) 

149. Other diseases of the organs of locomotion 

150. Congenital malformations (stillbirths not included) 

154. Seniiiiy 

160. Suicide by cutting: or piercing instruments 

167. Burns (conflagration excepted) 

171. Traumatism by cutting or piercing instruments 

185a. Dislocations 

185b. Sprains 

185c. Fractures (cause not specified) 

186. Other external violence 

187. Ill-defined organic disease 

189a. Cause of death not specified or ill-defined 



Total 155 



1 

e 

< 


i 

Q 


1 

G 


Q 


c 

a 
ft 

B 


3 

1 

11 



67 
183 

48 
72 
4 






3 

1 
8 
6 
63 
200 
57 
77 
4 












4 












5 






9 






2 








3 
56 
31 

3 

1 

7 
31 

5 
32 

6 
45 

2 
1,342 






1 

56 
31 
3 


2 








1 


1 




1 









7 
30 

5 
32 

7 
45 

3 
1,302 


1 






1"" 




j 




' 




1 




i|-- 


50 


6,409 


193 


1 26 


6,153 


192 



315 



BILIBID PRISON— REPORT OF DEATHS. 



4. 
5. 
14. 

28. 
30. 

:u. 

?A. 
35. 
64. 
68. 
79. 
91. 
92. 
93. 
94. 

95. 
108. 
115. 
116. 
119. 
120. 
160. 



Diseases. 
Malaria - -- 


Pre? 

Filipi- 
nos. 

6 

i 1 

S 1 fa 

1 L--- 


iidio. 

Chi- 
nese. 

1 6 
4 E 

1 £ 


Cai 

Filipi- 
nos. 

a) 
1 ! 


•eel. 

Chi- 
nese. 

: 6 


3 

o 
H 

2 
4 
3 
126 
1 
11 
1 


C 

i 
1 



1 

2 
54 

1 
5 


'onditions. 

•^ 1 1 

2 1 


Smallpox J 2 












2 


1 




Dysentery 


3 












I 




Tuberculosis of the lung-s 

Tuberculous meningitis 


97 
1 

8 


4 


1 


" 


21 


--- 


2 .... 


48 



2 
1 


23 



4 














2 ^--- 




Tuberculosis of other orprans. . 


-- 








Disseminated tuberculosis ' 1 




j 


1 




1 
3 




Cerebral haemorrhage apoplexy '. 














1 

7 
2 
3 

35 
1 

1 
1 

1 
1 
1 
1 
2 

6 
10 

221 


i 1 ■" 




Other forms of mental alienation . . ! 7 












3 
1 
2 

20 

1 
1 

1 

"i" 

1 

2 
4 


"14' 




Organic diseases of the heart .. . 


2 

2 

23 

1 
























11 




( 


1 

1 




Pneumonia 

Pleurisy 










1 i.— 




Pulmonary congestion, pulmonary 
apoplexy 

Gangrene of the lung 




1 




— . 








ij.... 




Appendicitis and typhlitis _ 1 1 

Other diseases of the liver - . 








































Diseases of the spleen. _. 


































Bright's disease . _... - 


















Suicide by cutting or piercing instru- 
ments -. - - -- - 


3 




1 




10 
51 




1 




9. 


1 


Other external violence 


8 1 
109 77 


1 ' 


Total 


157 


4 


2 


- 


- 


7 


— - 


85 ;.... 



Died in Bilibid Hospital, 193 ; legally executed, 10 ; died in San Lazaro Hospital, 18 ; total, 
221. 

PRISON SANITATION. 

BILIBID PRISON-LABORATORY EXAMINATION. 

Specimen. Number. 

Blood 2,303 

Blood (count) 156 

Faeces 16,477 

Sputum „ 4,289 

Urine 8,870 

Miscellaneous 1 142 

Total 32.237 

Blood specimen for: 

Washerman reaction „ 133 

Vidal reaction _ 131 



INDEX 

Acts : Page. 

2468 (Proposed amendment) 25 

2510 (Proposed repeal of Act) 25 

Pharmacy Inspection Board Bill 25 

Administrative decisions, Food and Drugs Act 27 

Albay Hospital 56-57 

Antipolo privy: 

Mindanao and Sulu 195 

Provinces 134-137 

Application for licenses, city of Manila 72 

Appropriations for health service in the provinces 85-88 

Artesian wells: 

Mindanao and Sulu 193 

Provinces 131,132 

Automatic Health Control: 

General remarks 18-20 

Provinces 144-153 

Automatic Health Control Tables: 

Death rate, Malolos and Paombong, by age groups (1913-1917).. 149 

Death, main causes, Malolos and Paombong (1913-1917) 149 

Death rate, comparative by municipalities (Cebu 1913-1917).... 151 

Deaths, Paombong, by age groups (1913-1917) 147 

Deaths, main causes, Paombong (1913-1917) 148 

Health Index, weekly, Bulacan Province, by municipalities (week 

ended December 28, 1918) 152 

Health Index, weekly, Hagonoy, 1918 150 

Mortality rate, tuberculosis, comparative, by municipalities (Bu- 
lacan, 1913-1917) 153 

Baby contests 204,225 

Bacteriological examinations : 

Bilibid Prison 33-34 

Mindanao and Sulu 169, 191-192 

Provincial Laboratories 123 

San Lazaro Hospital 54 

Baguio Hospital 29-30 

Bayombong Hospital 30-31 

Births: 

Bilibid Hospital 33 

City of Manila 247 

General Statistics 4 

Mindanao and Sulu 198 

Provinces 91-92 

Bontoc Hospital 36-41 

Beriberi : 

Bilibid 35 

Provinces 99 

317 



318 

Bilibid Hospital: Page. 

Beriberi 35 

Brigades 31-32 

• Cholera 34 

Eye diseases 35 

Filaria 34 

General medical survey 36 

Intestinal parasites 33 

Leprosy 34 

Morbidity 33 

Other contagious diseases 35-36 

Personnel 32 

Recommendations 36 

Respiratory disease 35 

Skin diseases 35 

Tuberculosis 35 

Vital statistics 32-33 

Water supply 32 

Blind, statistical table of 295 

Board of Food and Drugs Inspection 26-28 

Bulletin, Philippine Health Service 22 

Camp Claudio, Extra Cantonment Zone Work in 18 

Campaign : 

Balanced diet .1 20-21,227-228 

Better fecal disposal 228 

Healthier homes 20-21,224-225 

Home gardens 228 

Mosquito and fly, city of Manila 71 

Rat, city of Manila 70 

Carnival Exhibition of 1918: 

Campaign for proper disposal of water 224-225 

Campaign for proper handling of foodstuffs 224r-225 

Campaign for proper handling of drinking water 224-225 

Campaign for sanitary dwellings 224—229 

Carriers: 

Cholera 10, 34, 66, 161 

Diphtheria 69 

Cemeteries : 

Mindanao and Sulu 203 

Provinces 137 

Report on 28-29 

Chaulmoogra oil treatment of leprosy in Culion 45 

Cholera : 

City of Manila ., 65-68 

General 9-10 

Mindanao 158-161 

Provinces 112 

Cholera carriers in Bilibid 34 

Circulars : 

Division Provincial Sanitation 84--85 

Clean-up week: 

City of Manila 74 

Provinces : 143 



319 

Page. 

Clerical work 17 

Clinic, school, city of Manila 75-76 

Clubs, Women's 22, 127,204,225-227 

Congenital debility: 

Provinces 98 

Construction, Culion Leper Colony 41-43 

Convulsions : 

Provinces 98 

Council of Hygiene 25-26 

Culion Leper Colony: 

General remarks on 16-17 

Chaulmoogra oil treatment 45 

Construction in colony proper 41-43 

Construction in Balala 43 

General administration 44-45 

. Maintenance 44 

Payrolls .- 48 

Recommendations 46-47 

Research 45 

Subsistence report 47-48 

Cuyo Hospital 48-49 

Deaths : 

City of Manila 248 

General statistics 4 

Mindanao and Sulu 199 

Provinces 89-96 

Death tables: 
Manila — 

By ages 248 

By occupations : 279 

By social state 248 

By causes, sex and nationality 249-254 

By causes, sex, nationality and age 255-278 

Number and rate, by districts 248 

Number and rate, by quarters 247 

Mindanao and Sulu — 

By ages 199 

By causes 200 

By civil status 203 

By nationalities 199 

By provinces ;.... 199 

Dental caries among school children 129, 210 

Diarrhea and enteritis: 

Provinces 99 

Diphtheria : 

City of Manila 69 

General remarks on 11 

Diseases : 

Beriberi 35,99 

Cholera 9-10, 65-68, 112, 158-161 

Dental caries 129, 210 

Diphtheria H 59 



320 

Diseases — Continued. p*^^- 

Dysentery H, 65-68, 100, 107, 169-170 

Eye diseases ^^ 

Filaria ^^ 

Hydrophobia 69-70,121 

Influenza 6, 63-65, 116-120, 167, 168 

Intestinal parasites ^^ 

Malaria 12, 52, 99, 166-167 

Plague 12,23 

Smallpox 2, 8, 22-23, 61-63, 112-116, 162-166 

Tuberculosis 11, 35, 50, 52, 108-109 

Venereal diseases 34, 168-169 

Yaws 169 

Disinfections, in city of Manila, report of 71 

Dispensaries : 

City of Manila 285 

Mindanao and Sulu 172-175 

Provinces 124-125 

Disposal of Excreta: 

Mindanao 194-195 

Provinces 134-137 

District Nurses: 

Provinces 127-128 

District Nursing, Office of 236-237 

Division of Hospitals and General Inspection: 
Report of the Chief on activities of — 

Council of Hygiene.... 25-26 

Food and Drugs Inspection 26-28 

Provincial cemeteries 28-29 

Baguio Hospital 29-30 

Bayombong Hospital 30-31 

Bilibid Hospital 31-36 

Bontoc Hospital 36-41 

Culion Leper Colony 41-48 

Cuyo Hospital 48-49 

Iwahig Penal Colony 49-53 

Kiangan Hospital 53-54 

San Lazaro Hospital 54-56 

Albay Hospital 56-57 

Leyte Hospital 58 

Naga Hospital 58-60 

Division of Sanitation, city of Manila: 
Report of the Chief — 

General remarks 61 

Smallpox 61-62 

Vaccination 62-63 

Influenza 63-65 

Typhoid fever, dysentery and cholera 65-68 

Diphtheria 69 

Measles 69 

Hydrophobia 69 

Rat campaign 70 

Mosquito and fly campaign 71 

Report of disinfections 71 



321 

Division of Sanitation, city of Manila — Continued. 

Report of the Chief — Continued. Pa?re. 

Licenses 72 

Supervision of water supply 73 

Fines imposed 73 

Sanitary orders 73-74 

Clean-up week 74 

Medical inspection of schools 74-78 

Table of clinic work 76 

Table of school inspection 77 

Table of dangerous communicable diseases 78 

Division of Sanitation, Mindanao and Sulu: 

Report of the Chief — 

Organization 157 

Personnel 157 

Cholera 158-161 

Smallpox 162-166 

Malaria 166-167 

Influenza 167-168 

Veneral diseases 168-169 

Dysentery and typhoid 169-170 

Leprosy 170 

Dispensaries 172-175 

Hospitals 175-190 

Laboratories 191-192 

San Ramon Penal Colony 192-193 

Water supplies 193-194 

Disposal of Excreta 194-195 

Vital statistics -. 195-203 

Cemeteries 203 

Infant welfare 203-209 

Medical inspection of schools 210 

Markets and slaughterhouses 210-211 

Vaccination 211 

Extracts of reports of district health officers 212-223 

Summary 223 

Division of Sanitation of Provinces: 

Report of the Chief — 

Organization : 79-80 

Changes in personnel 80-83 

Table of health districts 80 

Table of sanitary organization 81 

Methods of securing information 83-84 

Circulars 84-85 

Financial statement 85-88 

Table of provincial health funds 86 

Vital statistics 88-97 

Prevalent diseases 98-100 

Communicable diseases 100-112 

Epidemics 112-120 

Mortality from communicable diseases 120 

Rabies 121 

168426 21 



322 

Division of Sanitation of Provinces — Continued. 

Report of the Chief — Continued. Page. 

Vaccination 122-123 

Laboratories 123-124 

Medical relief 124 

Infant welfare 124,126-127 

Public health nurses 127-128 

Medical inspection of schools 128-131 

Water supplies 131-132 

Markets and slaughterhouses 131, 133-134 

Disposal of excreta 134-137 

Cemeteries 137 

New ordinances 137, 139 

Sanitary orders and prosecutions 140-141 

Publicity 141,142 

Home gardens 141, 143 

Clean-up week 143 

Automatic health control 144-153 

Summary 153-154 

Recommendations 154-156 

Drafting projects of sanitary engineer..... 233-235 

Drug and food inspection 26-28 

Dysentery : 

City of Manila 65-68 

General 11 

Mindanao and Sulu 169-170 

Provinces 100,107 

Epidemics : 

Cholera 112,9-10 

General remarks 6 

Influenza 6, 63-65, 116-120, 167-168 

Smallpox 112-116,7-8 

Epidemic of influenza in: 

Baguio Hospital 29 

Bilibid 32, 33, 35 

Bontoc Hospital 39 

City of Manila 63-65 

Cuyo Hospital 49 

Iwahig Penal Colony 52-53 

Mindanao and Sulu 167-168 

Provinces 116-120 

Epidemiology : 

General remarks 6 

Work done in 1918 23 

Examinations, laboratory: 

Bilibid : 33-34 

Culion ..-. 45 

Mindanao and Sulu 191-192 

Provincial laboratories 123 

Excreta, Disposal of: 

Mindanao and Sulu 194-195 

Provinces 134-137 



323 

Exhibits, health: Page. 

At 1918 Carnival 224-225 

Provinces 141 

Filariasis in Bilibid Prison 34 

Financial support of provincial health organizations 85-88 

Financial statement: 

Provinces 85-88 

Fines for violating sanitary ordinances: 

City of Manila 73 

Fly campaign, city of Manila 71 

Food and Drugs Inspection 26-28 

Food and Drugs Inspection, report of articles 26-28 

Food campaign 141-143,228 

Garbage disposal: 

Davao 214 

Iwahig Penal Colony 51 

Gardens, home 141-143,228 

General medical survey in Bilibid Prison 36 

Home Gardens: 

Campaign ... 228 

Provinces 141, 143 

Hospitals : 
Insular — 

Baguio 29-30 

Bayombong 30-31 

Bilibid 31-36 

Bontoc „ 36-41 

Cuyo 48-49 

Iwahig 49-53 

Kiangan 53-54 

San Lazaro Hospital 54-56 

Mindanao and Sulu 175 

Butuan 176-177 

Cotabato 177-180 

Lanao 180-182 

Misamis 183-184 

Sulu 184-186 

Zamboanga 168-188 

Rizal Memorial (Dapitan) 189-190 

Provincial — 

Albay 56-57 

Leyte 57 

Naga 57-60 

Hydrophobia : 

City of Manila 69-70 

Provinces 121 

Hygienic campaign: 

Better fecal disposal 228 

General remarks 20-21 

Home gardens 228 

Improvement of diet 227-228 

Sanitary dwellings at Carnival 20-21 

Hygiene, Council of 25-26 



324 

Page. 

Hygienic and Industrial Development, Office of 224-228 

Industrial Hygiene 224-228 

Infant Mortality: 

City of Manila 248 

Mindanao and Sulu .-.. .... 199 

Provinces 93,97 

Infant Welfare : 

By v^romen's clubs 225-227 

Mindanao and Sulu 203-209 

Provinces 124,126-127 

Influenza : 

City of Manila 63-65 

General remarks on 6 

Mindanao and Sulu 167-168 

Provinces . 116-120 

Information Service: 

Provinces 83-84 

Insane Department of San Lazaro Hospital.... 305 

Inspection, Division of General 25-29 

Inspection, Medical, of schools: 

City of Manila 74-78 

Mindanao and Sulu 210 

Provinces 128-131 

Intestinal Parasites in Bilibid Prison 33 

Iw^ahig Penal Colony 49-53 

Laboratories : 

Mindanao and Sulu 191-192 

Provinces 123-124 

Lectures, public health 141-142 

Lepers, Examination of, in San Lazaro Hospital 54 

Leprosy : 

Bilibid Hospital 34 

Culion Leper Colony 41-48 

Mindanao and Sulu 170 

San Lazaro Hospital 54-55 

Leyte Hospital 58 

Licenses, city of Manila.. 72 

Malaria : 

General remarks 12 

Iwahig Penal Colony 52 

Mindanao and Sulu 166-167 

Provinces 99 

Markets : 

Mindanao and Sulu 210-211 

Provinces 131,133-134 

Marriage statistics: 

City of Manila 245-246 

Mindanao and Sulu 195-198 

Provinces 91 

Measles : 

City of Manila 69 

Provinces 107 



325 

Medical Inspection of Schools: PuKe. 

City of Manila 74-78 

Mindanao and Sulu ' 210 

Provinces 128-i:U 

Medical Relief: 

Provinces 124 

Methods of securing prompt information 83-84 

Mindanao and Sulu, report of division of 157-223 

Miscellaneous sanitary work during 1918 23-24 

Mortality rate in Bilibid Prison 32 

Mortality tables: 
Manila — 

Comparative, 1908 to 1918, by months 281-282 

Comparative, 1908 to 1918, by quarters 282 

Cholera, dysentery and typhoid fever .-. 65 

Diphtheria 68 

Influenza - 63 

Measles ...--- 69 

Rabies by districts 70 

Rabies by months .. 69 

Provinces — 

By ages 94-96 

By provinces 90-92 

Communicable diseases -•. 100, 120 

Prevalent diseases 98 

Mosquito and fly extermination, Manila 71 

Mosquito extermination, city of Manila 71 

Municipal Sanitation : 

Mindanao and Sulu 212,213,214,215,216,217,219,222 

Naga Hospital 58-60 

New developments in sanitary science 20-21 

New sanitary ordinances in provinces 137, 139 

Nurses, public health: 

City of Manila 236-237 

Mindanao and Sulu 203-209 

Provinces 127-128 

Nursing, office of district 236-237 

Nursing, Public Health ....—.....-... 17-18 

Officers serving with Philippine National Guard 6 

Officers serving with U. S. Army 5 

Orders: 

Sanitary, in provinces ----........ ... 139-141 

Sanitary Engineering 230-232 

Ordinances, new: 

Provinces 137-139 

Organization: 

Division of Mindanao and Sulu 157 

Division of sanitation in provinces 79-80 

Personnel : 

Bilibid Hospital : 32 

General remarks on 4-6 

Mindanao and Sulu 157 

Provinces 79-80 



326 

Philippine National Guard: Page. 

Officers of Serving with Guard 6 

Sanitary Work in Camp Claudio .— 18-20 

Plague 12,23 

Population : 

Manila ; 245 

Prevalent Diseases: 

Provinces 98 

Property, Office of 239-241 

Prosecutions : 

City of Manila 73 

Provinces 14(^-141 

Sanitary Engineering 233 

Prostitutes in Davao 168 

Provincial cemeteries, report on 28-29 

Publicity : 

General remarks 22 

Provinces 141 

Public Health Nursing: 

City of Manila 236-237 

General remarks 17-18 

Mindanao and Sulu 

Provinces 127-128 

Rabies : 

Provinces 121 

Rat Campaign, Manila — 70 

Recommendations : 

Bilibid Hospital .- 36 

Bontoc Hospital 41 

Culion Leper Colony 46-48 

Division, provincial sanitation 154-156 

San Lazaro Hospital 55-56 

Report of the Director of Health: 

The year in brief 3 

Vital statistics 3-4 

Personnel , 4-5 

Resignations 5 

Retirements 5 

Death 5 

Officers who served in U. S. Army 5 

Officers who served in Philippine National Guard 6 

Epidemic diseases 6 

Influenza 6 

Smallpox 7-8 

Cholera 9-10 

Other Communicable Diseases — 

Typhoid fever 10-11 

Dysentery 11 

Diphtheria 11 

Tuberculosis 11-12 

Malaria 12 

Plague 12 



327 

Page. 

Sanitation in the city of Manila 12 

Sanitation in the provinces -- - 12-13 

Sanitation in Mindanao and Sulu 13 

Hospitals 13-14 

Sanitation Bilibid Prison 14-16 

San Lazaro Hospital 16 

Culion Leper Colony 16-17 

Clerical Office 17 

Public health nursing 17-18 

Automatic health control .- 18 

Extra Cantonment Work, Camp Claudio 18-20 

New developments in Sanitary Science .-. 20-21 

Summary of work in 1918: 

Sanitary work in the provinces 22 

Special sanitary and hygienic activities 22-23 

Epidemiology 23 

Various work 23-24 

Reports of: 

Clerical Office ..- 238 

Division of General Inspection and Hospitals 25-60 

Division of Sanitation, city of Manila 61-78 

Division of Sanitation, Mindanao and Sulu 157-223 

Division of Sanitation in the Provinces 79-156 

District Health Officers: 

Agusan 212 

Bukidnon 212-213 

Cotabato '. 213-214 

Davao 214-215 

Lanao 215-217 

Misamis 217-218 

Sulu 218-220 

Surigao 220-221 

Zamboanga 221-223 

Office of District Nursing 236-237 

Office of Hygienic and Industrial Development 224-228 

Office of Sanitary Engineering 229-235 

Research work in Culion 45 

Resignations 5 

Retirements 5 

Resume by Director of Health 22-24 

Sanitary Divisions, Organization of — 

Mindanao and Sulu 157 

Provinces 79 

Sanitary Engineering: 

Manila 229 

Provinces 229 

Sanitary Orders: 

City of Manila 73 

Provinces 140-141 

Sanitary work in the provinces: 

General remarks 22-24 



328 

Sanitation in the city of Manila: paKe. 

Special features 12 

Sanitation in Mindanao and Sulu: 

Special features 13 

Sanitation in the Provinces: 

Special features 12-18 

Sanitation of Prisons: 

Bilibid 14-16,31-36 

Iwahig 49-53 

San Ramon 192-193,222-223 

San Lazaro Hospital: 

Admission of patients, report 54 

Examination of lepers 54 

General remarks on 16 

Subsistence report 55 

Recommendation of chief 55-56 

Schools, Medical Inspection of: 

Manila 74-78 

Mindanao and Sulu 210 

Provinces 128-131 

Separations from, the service 5 

Sera, Report of 296 

Simple Meningitis: 

Provinces 98 

Skin diseases: 

Bilibid Hospital 35 

Schools of Mindanao 210 

Slaughter houses: 

Mindanao and Sulu 210-211 

Provinces ;. 131, 133-134 

Smallpox : 

City of Manila 61-63 

General 7_8 

Mindanao and Sulu 162-166 

Provinces 112-116 

Special sanitary and hygienic activities 1918 22-23 

Statistics : 

Miscellaneous, city of Manila — 

Applications for licenses. Report of action taken 288 

Births according to number of children borne by mother 247 

Births by districts 247 

Births, number and rate among residents, by nationalities...' 245 

Cholera and plague 283 

City Morgue Report 286 

Deaths by ages 248 

Deaths, by occupations 279 

Deaths, classified by social state, including transients 248 

Deaths classified by causes, sex and nationality 249-254 

Deaths classified by causes, sex, nationality and age 255-278 

Deaths, number and rate per 1,000, including transients, by 

districts 248 

Deaths, number and rate per 1,000 among residents, by 
nationalities 247 



329 

Statistics — Continued. 

Miscellaneous, city of Manila — Continued.^ PaKc 

Disinfections report ' 287-288 

Disinterments 286 

Disposition of dead bodies 286 

General inspections and sanitation work in health stations.... 287 

Infant mortality 280-281 

Marriages by ages 245 

Marriages by nationalities 246 

Mortality, comparative, 1908 to 1918, by months 281-282 

Mortality, comparative, 1908 to 1918, by quarters 282 

Mosquito campaign operations 284 

Population by districts 245 

Population by nationalities 245 

Rat campaign operations 284 

Sanitary orders 284 

Sick and wounded attended by municipal physicians 285 

Smallpox 283 

Tuberculosis, cases reported by nationalities and districts.... 284 

Varicela 283 

Varioloid 283 

Miscellaneous, provinces — 

Blind Persons Report 295 

Cholera, by provinces and towns 289-294 

Insane Persons Report 296 

Mortality among Government employees 299 

Sera Report 296 

Vaccinations, Manila and provinces 298 

Vaccine, received and distributed 297 

Application for licenses 72 

Clinic work in schools 76 

Morbidity and mortality from cholera, dysentery and typhoid 

(1917-1918) ; 65 

Morbidity and mortality from diphtheria 68 

Morbidity and mortality from influenza 63 

Morbidity and mortality from measles 69 

Morbidity and mortality from rabies by districts 70 

Morbidity and mortality from rabies by months 69 

Table of school inspection 77 

Table of dangerous communicable diseases found among 

pupils 78 

Vaccinations, 1918 62 

Report, Division of Mindanao and Sulu — 

Cemeteries 203 

Cholera by months 159 

Cholera by municipalities 160 

Deaths, classification by ages 199 

Deaths, classifications by causes 200 

Deaths, classification by civil status 203 

Deaths, classification by nationalities 199 

Deaths, classification by provinces 199 

Dispensaries 172 

Dispensaries, consolidated report 172-174 



330 

Statistics — Continued. 

Report, Division of Mindanao and Sulu — Continued. Pai?e. 

Dispensaries, consolidated by provinces 175 

District Nursing 204-209 

Hospital Case Report, Consolidated, Butuan 176 

Hospital Case Report, Consolidated, Cotabato 177-178 

Hospital Case Report, Consolidated Lanao 180-181 

Hospital Case Report, Consolidated, Misamis 183 

Hospital Case Report, Consolidated, Sulu 184-185 

Hospital Case Report, Consolidated, Zamboanga 186-187 

Hospital Case Report, Consolidated, Rizal Memorial 189 

Hospital Case Report, Consolidated, San Ramon Penal 

Colony 192-193 

Laboratory Examinations by provinces 191-192 

Malaria by provinces 167 

Marriages by ages 196-198 

Marriages by provinces 195-196 

Medical Examinations by schools 210 

Other communicable diseases, incidence of and mortality 

from 171 

Smallpox by months 164 

Smallpox by municipalities .— 165-166 

Vaccination 211 

Venereal diseases 169 

Report, Division of Provinces — 

Automatic Health control tables 147-153 

Cemeteries — 138 

Cholera outbreaks by months 110-111 

Deaths from communicable diseases 101-105 

Excreta disposal 135 

Dispensaries, condensed report of 125 

District Nursing 127 

Health Fund by provinces .• 86 

Home gardens 143 

Infant w^elfare , 126 

Infant mortality by provinces (1916, 1917, 1918) 97 

Influenza mortality 117 

Laboratories ^ 128 

Markets and slaughterhouses 133 

Medical inspection of schools 129 

Medical inspection of schools (Diseases found) 130 

Mortality, comparative by age groups (1916, 1917, 1918).... 94-96 

Mortality, comparative from prevalent diseases 98 

Mortality statistics, condensed, by provinces (1916, 1917, 

1918) 90-92 

Publicity 142 

Puerperal state, mortality from 128 

Rabies ..- 121 

Sanitary orders and prosecutions 140 

Sanitary organizations 81 

Smallpox outbreaks by months 113-114 

Vaccination 122 

Water supplies 132 



331 

Statistics — Continued. 

Report Hospital Cases — Pa^e. 

Baguio Hospital .- 300-301 

Bayombong Hospital 302 

Bilibid Hospital .-. 313-315 

Bontoc Hospital 303-304 

Cuyo Hospital ..- 305 

San Lazaro Hospital 305-312 

Report, Oflfice of District Nursing — 

Work done in Manila and provinces 237 

Report, Office of Property — 

Commissary requisitions, incoming 240 

Commissary requisitions to Bureau of Supply 240 

Commissary, under direct order and payment system 240 

Incoming requisitions , 239 

InterbureaU vouchers 241 

Requisitions to Bureau of Supply 239 

Vaccine report 240 

Report, Office of Publicity — 

Home gardens 228 

Puericultural centres : 227 

Women's clubs 225-227 

Report, Off.ce of Sanitary Engineering — 

Building licenses by districts, Manila 231 

Building licenses by quarters, Manila 231 

Drafting projects 233 

Plumbing licenses by districts, Manila 231 

Plumbing licenses by quarters, Manila 231 

Prosecutions by districts, Manila 231 

Prosecutions by quarters, Manila 231 

Sanitary orders by districts, Manila 230 

Sanitary orders by quarters, Manila 231 

Subsistence Statement : 

Bayombong Hospital 31 

Bontoc Hospital 41 

Culion Leper Colony 47-48 

Cuyo Hospital 49 

Iwahig Penal Colony 50-51 

San Lazaro Hospital 55 

Albay 57 

Sulu Hospital 184-186 

Summary of Report: 

Director of Health 22-24 

Mindanao and Sulu 223 

Provinces 153-154 

Supervision of Manila Water Supply 73 

Survey, general medical, in Bilibid Prison 36 

Tuberculosis : 

General H 

Bilibid Prison 35 

Iwahig 50,52 

Provinces 108-109 



332 

Typhoid fever: Page. 

City of Manila : 65-68 

General 10-11 

Mindanao and Sulu 169-170 

Provinces 107-108 

Vaccination : 

City of Manila 62-68 

Mindanao and Sulu 211 

Provinces 122-128 

Vaccine Report: 

Chief, oliice of property 240-241 

Venereal diseases: 

Bilibid Prison ...-- 34 

Mindanao and Sulu 168-169 

Vital statistics: 

Bilibid Prison 32-38 

General 3-4 

Manila 245-248 

Mindanao and Sulu 195-203 

Provinces 88-97 

Water examination "Zamboanga Laboratory 194 

Water supplies: 

Bilibid Prison 32 

Mindanao and Sulu 193-194 

Provinces 131,132 

Supervision of Manila 73 

Wells, artesian: 

Mindanao and Sulu 193 

Provinces 131, 132 

Women's Clubs 22, 127, 204, 225-227 

Yaws, reported by hospitals and dispensaries, Mindanao 169 

Zamboanga Hospital 186-188 



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